NAACOS TO CO-HOST CONGRESSIONAL BRIEFING
NAACOS is joining the House Health Care Innovation Caucus to co-host a value-based care briefing for congressional staff on April 27. Reps. Mike Kelly (R-PA) and Ami Bera (D-CA), the co-chairs
of the caucus, will kick off the briefing, which will be held in the U.S. Capitol. The briefing will educate staff on how value-based health care is improving patient care, strengthening the
delivery system, increasing flexibility for providers, and lowering costs. A recording will be available following the event. Please reach out to
Robert Daley if you would like
more information about how to invite staff from your congressional delegation to attend the briefing.
CONGRESSIONAL UPDATES
LAWMAKERS DISCUSS HEALTH COSTS AND SPENDING
Prior to departing for the two-week recess, congressional committees were busy holding hearings on the President Biden’s budget request and discussing health care costs. Health and Human
Services (HHS) Secretary Xavier Becerra appeared before lawmakers in the House and Senate to discuss the President’s health care priorities. The House Energy and Commerce Health Subcommittee
also held a hearing to discuss health care costs. Lawmakers discussed the status of hospital price transparency rules and focused on consolidation in the health system. Several members called
for more transparency and oversight of the 340B program, along with reforms to pharmacy benefit managers (PBMs). The Senate Finance Committee also held a bipartisan hearing focused on PBMs and
their role in increasing drug costs. Congress will reconvene on April 17. Members will continue to focus their attention on Fiscal Year (FY) 2024 funding and negotiations to increase the
national debt limit.
ADMINISTRATION UPDATES
MA RISK ADJUSTMENT CHANGES TO BE PHASED IN
CMS is finalizing proposed changes to the risk adjustment model used by both Medicare Advantage (MA) and ACOs but will phase in those changes over a three-year period. The changes in the
Hierarchical Condition Categories risk adjustment model were included in the 2024 MA Rate Announcement that includes a 3.32 percent overall payment increase for MA plans. NAACOS
had expressed concern about the downstream impact on provider payment and applying this new risk
adjustment model to ACOs, and we recommended that CMS phase these changes into the new model. We will continue to evaluate the impact of the risk adjustment model changes to MSSP and REACH.
The press release,
fact sheet, and
rate notice are all available online.
CMMI’S MA VBID MODEL EXTENDED THROUGH 2030
CMS recently announced it will extend the MA Value-Based Insurance Design (VBID) Model through 2030, introducing
health equity plans for all participants along with additional reporting requirements. The model allows MA plans flexibility in benefit designs to better offer value-based approaches to
enrollees targeting chronic conditions, socioeconomic status, or both, and more flexibility in the use of rewards and incentives. A summary of all model updates is available in this
fact sheet.
Hospice. CMS is proposing an overall 2.8 percent increase in payments for hospice providers, along with extending telehealth flexibility for hospice providers through
the end of 2024. The agency is also codifying the Hospice Quality Reporting Program data submission threshold that was previously adopted by CMS in 2016.
Inpatient Rehab. CMS is proposing a 3.7 percent increase for inpatient rehabilitation facilities. The agency will also allow hospitals to open new rehabilitation
facilities at any time during a cost-reporting period.
REMINDER: MSSP APPLICATION CYCLE OPENS NEXT MONTH
Applications to participate in the Medicare Share Savings Program (MSSP) beginning January 1, 2024, will be accepted from May 18 to June 15, 2023, at 12:00 pm ET. As a reminder, ACOs will not
be required to submit a Notice of Intent to Apply (NOIA) in order to be eligible, unlike in previous years. Key application
dates and deadlines, as well as
initial guidance for Advance Investment Payment (AIP) applicants are available. An updated
application toolkit and sample application
materials will be made available in the coming weeks.
WELCOME NEW BUSINESS PARTNERS
BPCI-A OVERVIEW WEBINAR NOW AVAILABLE ON DEMAND
CMMI recently hosted a webinar on the RFA for Model Year 7, starting on January 1, 2024, of the
Bundled Payments for Care Improvement-Advanced (BPCI-A). The
recording is now available and provides an overview of the model updates as well
as the RFA process. BPCI-A is a voluntary episode payment model and has been extended for two years to run through December 31, 2025. There is now an open RFA for Medicare-enrolled providers,
suppliers, or ACOs to start participation in the model for Model Year 7. The deadline for submitting an application is May 31, 2023, at 5:00 pm ET. Questions about the application process can
be directed to BPCIAdvanced@cms.hhs.gov.
MEDICARE’S INSOLVENCY PUSHED TO 2031 Medicare Trustees report the Hospital Insurance Trust Fund will be solvent until 2031, which is three years
later than reported last year. The improved outlook is due to several factors, including those who died during the COVID-19 pandemic having higher Medicare spending and more dually-eligible
beneficiaries moving to MA.
EDUCATIONAL EVENTS
HEAR FROM CMS LEADERS AT THE SPRING 2023 CONFERENCE Join us May 3-5, 2023, for the NAACOS Spring Conference at the Hilton Baltimore Inner Harbor to hear directly from
CMS officials who shape ACO and value-based care policy and operations. In addition, this two-day, in-person event will feature
16 breakout sessions with actionable knowledge for new ACOs joining the MSSP and REACH models, rural ACOs, independent primary care
ACOs, and experienced ACOs in all models. Full Agenda available. Plenary sessions will feature:
Meena Seshamani, Director, Center for Medicare, CMS
Liz Fowler, CMS Deputy Administrator and CMMI Director
John Pilotte and Pauline Lapin, CMS at the Town Hall
There is still time to register! Registration for the in person and
virtual conference will remain open until the conference begins. **GROUP RATES** Take advantage of our
group rates! We are offering group rates for both in-person and virtual participation in the conference. To register at the group rate, please contact
Emily Perron. Sponsor opportunities are still available!Partners reserve your exhibit space today!
SUMMER 2023 BOOT CAMP REGISTRATION IS NOW OPEN Mark your calendars for June 15-16 at the
Denver Airport Marriott at Gateway Park for the Summer 2023 Boot Camp on data and analytics for new and advanced
ACOs. This boot camp will meet the educational needs of ACO leadership and staff, including those responsible for building and overseeing data, analytics, and ACO financial interests.
Boot camp topics have been announced with the full agenda to be released in the coming weeks.
Register NOW!
**This boot camp will only be offered in person. There will be no virtual option. Boot camps are not open to business partners. Space is limited to 100 people.**
MEDICAID LEARNING LAB ON HOME CARE FOR DISABLED TOMORROW Join the Medicaid Learning Lab monthly series for NAACOS ACO members. The virtual meetings in this series began December 2,
2022, and will continue in monthly 90-minute sessions through December 2023 on the first Friday of every month from 2:00 pm to 3:30 pm ET. This Learning Lab covers value-based care models to
support your contracted populations and networks, various Medicaid models throughout the states, workflow options for value-based care related to primary care, social determinants of health,
behavioral health, and high needs people, plus how to improve quality and enhance patient engagement in the Medicaid population. The April 7th meeting will feature Dr. William Mills, MD,
Senior Vice President for Medical Affairs, BrightSpring Health Services as he presents ‘Home-Based Primary Care Improves Outcomes in People with Intellectual and/or Developmental Disability.’
Dr. Mills will familiarize the audience with clinical challenges faced by people with intellectual and/or developmental disability and discuss how the use of value-based outcome measures and
home-based primary care may improve outcomes in this vulnerable population. There is also an opportunity to listen to recordings of previous sessions and complete a post-program strategic plan
for your ACO to obtain a course completion certificate. Register now to receive the event meeting link.
WEBINAR: UTILZING MSSP FILES AND BENCHMARK ESTIMATOR TOOL
NAACOS will host a webinar on April 19 from 12:30 pm to 1:30 pm ET on using the MSSP 4th Quarter Files that ACOs received in March. These files along with the CMS estimator tool can provide
ACOs with the best possible prediction of your MSSP yearly final results. Join us to learn from
Jimmy Johnson, Director of IT and Analytics, and Dr. Mike Romano, Chief Medical Officer, both from Nebraska Health Network, as well as Jennifer Leazzo, Vice President of Analytics for Duly
Health and Care, how they utilized these files not only to predict yearly outcomes but also to define clinical improvement.
Register today and add this event to your calendar.
MEMBER RESOURCES
EPISODE DATA SHOWS WIDE VARIATIONS IN ORTHOPEDIC SURGERY COSTS
In 2021, a Medicare 90-day major joint replacement episode in one large southern city cost between $18,000 and $36,000 depending on the hospital where the surgery was performed. The percentage
of patients discharged to a post-acute facility ranged from 3 percent to 50 percent depending on the hospital. Episode-of-care data are an invaluable tool to help ACOs identify which hospitals
they should partner with.
Last month, NAACOS and the Institute for Accountable Care released complimentary episode spending reports to each ACO member participating in MSSP with results in 2021.
Get more information on how to download and use your free report The Institute for Accountable can provide detailed
data about the relative performance of hospitals and physician groups in your market.
Contact the Institute to learn more about using episode spending data to inform
your decisions about hospital and physician partnership opportunities.
SNF 3-DAY WAIVER OPERATIONAL INFORMATION IN REVIEW
Some questions have recently been posted on the NAACOS Listserv concerning how others have operationalized their Skilled Nursing Facility (SNF) 3-Day Waivers. This topic is being pushed to the
top of operational leader’s minds as the public health emergency ends on May 11 and the SNF 3-day waiver is no longer covered for all Medicare beneficiaries. NAACOS is currently organizing a
webinar to occur in mid-May on this topic. Until then, members can view
MSSP 3-Day SNF Waivers: Exploring Compliance and Operational Issues
that was originally presented in December of 2022.
DISCOUNTED SUBSCRIPTION TO HEALTHEXECWEEK
NAACOS would like to share an exclusive offer for our members and partners from HealthExecWire for the newsletter HealthExecWeek. NAACOS members and partners may take advantage of a 25 percent
discount off the regular subscription price. Subscribe now for $348.
WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE
Senators
introduce legislation
to improve the way MA plans assess patients’ health risks and reduce overpayments.
Health Affairs Forefront explores approaches to
accounting for social risk factors in Medicare and Medicaid payment.
Recent
Milbank Quarterly
publication proposes strategies for CMMI to better engage patients and clinicians in alternative payment models, reduce selection bias and model overlap issues, and better transition
away from fee-for-service.
