CAN’T
TRAVEL? ATTEND SPRING CONFERENCE VIRTUALLY! ACOs, DCEs, and other
models focusing on population health can create a future where quality is better, costs
are lower, and patients are engaged. Join us on April 28–29 from the comfort of your
home, office, or wherever it may be, and hear from leading value-based care experts and
CMS officials sharing timely and essential information for ACOs and other alternative
payment models. A detailed
agenda is available!
Register Now Registration is
still open for the virtual conference! Individuals unable to attend the conference
in person can participate in the live webcast of the conference. The live webcast
includes all of the breakout sessions and plenaries as well as the sponsored breakfasts.
Live webcast participants also receive six months of access to the recordings of the
sessions so that you don’t miss out on any of the sessions! Please note, the live
webcast does not include any of the pre-conference workshops.
NAACOS conferences are the only events organized
exclusively by ACOs and DCEs. Get more information on conference registration and hotel
details.
COVID-19
PHE EXTENDED INTO JULY Effective April 16, Health and Human Services
(HHS) Secretary Xavier Becerra renewed the COVID-19 Public Health Emergency (PHE) for an
additional 90 days, as NAACOS had been expecting. With another 90-day extension, the PHE
will now last through July 15. A number of Medicare polices are tied to the PHE,
including CMS waiving shared losses for MSSP ACOs, removing COVID-19 treatment episodes
from PY expenditures, and broad application of telehealth waivers. More information is
available on COVID-19. We are continuing to monitor the PHE’s timeline and will alert
members of significant happenings.
MORE
ACO REACH DEADLINES ANNOUNCED The CMS Innovation Center recently
announced two key upcoming deadlines for the ACO REACH Model. The deadline to add
providers will be August 4, and the deadline to drop providers is September 9. Both of
these dates coincide with the MSSP. NAACOS understands these are tight turnarounds that
put a lot pressure of ACOs, especially since financial information won’t be released
until this summer. The agency still hopes to send decisions on 2023 applications by late
June. More information is available on the Innovation Center calendar.
CMS
RELEASES PROPOSED PAYMENT RULES On April 18, CMS issued the Fiscal Year
(FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term
Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule. Comments on the
proposed rule are due by June 17. The fact sheet and proposed rule are available. CMS proposes to increase inpatient
hospital payments by 3.2 percent in FY 2023. Long-term care hospitals would see an
increase of $25 million while Medicare dependent hospitals would see a $0.6 billion
decrease in payments unless Congress passes legislation to stop the reductions. CMS is
proposing to apply a 5 percent cap on any decrease to a hospital’s wage index from the
prior year. CMS is proposing to require hospitals to continue COVID-19 and seasonal
influenza reporting after the end of the PHE.
The proposed rule also builds
on the Biden administration’s key priorities to better measure health care quality and
disparities. Specifically, CMS is seeking comments on how the reporting of social
determinants of health (SDOH) diagnosis codes may improve the ability to recognize
severity of illness, complexity of service, and/or utilization of resources. The
proposed rule also seeks comments on ways to address disparities and advance health care
equity. CMS also proposed several changes to Electronic Clinical Quality Measures
(eCQMs) and hybrid measures with another request for information to gather comments on
continued advancements to digital quality measurement and the use of the Fast Healthcare
Interoperability Resources (FHIR) standard for eCQMs.
On March 30, CMS also
released the FY 2023 Skilled Nursing Facilities Prospective Payment System (SNF PPS)
Proposed Rule that would reduce Medicare nursing home pay by $320 million in FY 2023 to
ensure that the program remains budget neutral. Comments on the proposed rule are due by
June 10. The fact sheet and proposed rule are available. As with other FY 2023 proposed
rules, CMS is proposing a 5 percent cap on wage index decreases. The proposed rule
includes a request for information on the implementation of federal staffing minimums,
the creation of a staff turnover measure for use in the value-based purchasing program
(VBP), and the establishment of a health equity measure as part of the nursing home star
ratings system. CMS also proposes the adoption of several new measures into the SNF VBP
Program, including measures that assesses the rate of successful discharges to community
from a SNF setting.
Welcome
New Business Partners
Allymar
Health Solutions Allymar
Health Solutions was built to bring value and drive accurate HCC
coding via its proprietary end-to-end technology enabled Medicare
Advantage platform. allymarhealth.com
Gallagher
Re A
global reinsurance broking and advisory firm across the risk and
capital spectrum, revitalizing the industry, redefining innovation,
and reimagining what’s possible. ajg.com/gallagherre/
AristaMD AristaMD
is focused on improving health equity and patient outcomes through
more timely access to specialty care. aristamd.com
Lumeon Our
award-winning orchestration platform enables providers create and
automate programmable care journeys, transforming their EHR into an
agile care delivery platform to engage patients & care teams
beyond the hospital’s four walls. lumeon.com
Cricket
Health Cricket
Health is a value-based provider of kidney care focused on
identifying undiagnosed chronic kidney disease and delivering
proactive disease management and education. crickethealth.com
Newtopia Newtopia
is a tech-enabled habit change provider focused on disease
prevention and reducing the cost of care. newtopia.com
FeelBetter
US Inc. FeelBetter
enables value-based programs (VBP) to focus on polypharmacy patients
that can yield the most significant impact on clinical and financial
outcomes. feelbetter.healthcare
Rimidi,
Inc. Rimidi’s
leading clinical management platform empowers healthcare
organizations to optimize clinical workflows, enhance patient
experiences and achieve quality objectives. rimidi.com
Fitscript FITSCRIPT
LLC is a digital health and fitness company providing online and in
person fitness and coaching to people living with diabetes and
chronic conditions around the globe. glucosezone.com
ThoroughCare ThoroughCare’s
intuitive software, analytics, and mobile applications are designed
to support a holistic, continuum of care for healthy patients and
thriving practices. thoroughcare.net
LAST
CHANCE TO SEND QUESTIONS FOR CMS TOWN HALL Next week hundreds of ACOs
from across the country will convene in Baltimore for the jam-packed NAACOS Spring 2022
Conference. The CMS Town Hall is among the many anticipated educational sessions
and events. During the Town Hall, CMS leaders will share insights on where the
transition to value is headed and will answer ACO questions on a range of important
policy and ACO program aspects. Live audience questions will be answered along with
questions submitted in advance. We encourage ACOs to send us questions before April 23
by emailing us at advocacy@naacos.com with the
subject line, “Town Hall.”
CONGRESS
EYES MIDTERM WINS Congress is out of Washington, D.C., this week and in
a work period in members’ respective states and districts. With a heated election
primary season underway and members looking toward the midterm elections in November,
the need for wins that can be touted on the campaign trail becomes more urgent.
Republicans are favored by pundits and pollsters to win the U.S. House, and GOP offices
have begun drafting concrete ideas concerning health access for rural populations and
digital health. On the majority side, Democrats see a swiftly closing window to pass
drug pricing legislation or lower healthcare costs, creating an appetite to revive
reconciliation legislation considered earlier this Congress. At the same time, time
sensitive legislation like the medical device and pharmaceutical user fees bills and
pending COVID relief are also taking up time on the calendar. During the first week of
April, which was the last week that Congress was present in Washington before
adjourning, COVID reared its head again, infecting congressional members and staff and
perhaps raising the likelihood that COVID relief could pass when Members return to the
Capitol next week.
Throughout this year NAACOS will be advocating hard to
extend the 5 percent Advanced Alternative Payment Model incentive, among other advocacy
priorities. We strongly encourage ACOs to engage in advocacy efforts in a variety of
ways, such as by sending a message through our grassroots center and contacting lawmakers while
they are at home in their districts.
NAACOS
ACTION FUND PRIOR APPROVAL FORMS AVAILABLE ONLINE The NAACOS Action
Fund is a political action committee to support congressional candidates who understand
the interests of NAACOS members and value-based care providers. If you are your
organization’s primary contact with NAACOS, and you have not already done so, we
encourage you to visit our website to review and electronically sign the NAACOS Action Fund Prior Approval form. The web-based form
includes frequently asked questions and instructions. NAACOS staff will also be at the
Spring 2022 Conference in Baltimore to answer questions and accept signed forms.
DATA
MAKES THE ACO GO ‘ROUND! Everything we do in value-based care
contracting revolves around data. NAACOS understands this, and we will take a deep dive
into ACO data needs at our upcoming Summer Boot Camp June 16 and 17 in Nashville at the Sonesta Nashville
Airport. This boot camp will provide an opportunity to learn from ACOs with
demonstrated success in harnessing data to drive positive performance outcomes. Boot
camp faculty will present how they use data to drive these processes. We will include
breakout sessions that take a deeper look into technical questions around benchmarking,
dashboards, claims and coding data.
Some examples include:
Creating dashboards to support the needs of leadership, providers, and staff
Using claims data for risk calculation
Thinking through data resource needs for population health strategy and outcome
tracking
Understanding how to assess year over year population trends using claims and
electronic medical record data
Evaluating specialist performance in ACOs
This boot camp is designed for the ACO leadership team, including executive directors,
population health staff, as well as data, analytics, and information technology (IT)
team members. We will have workshops that speak the language of those responsible for
data management and reporting in ACOs. Registration is now open. This summer boot camp will only be
offered in person; there is no virtual option. Boot camps are not open to business
partners. Space is limited to 100 people from ACOs!
NAACOS
LAUNCHES DIGITAL QUALITY TASK FORCE NAACOS recently announced the
launch of its Digital Quality Measurement Task Force (Task Force) aimed at developing
recommendations for how to successfully collect and electronically report on ACOs’
quality of care through disparate health IT systems. CMS has made it a goal to fully
move to digital quality measurement by 2025. The Task Force will convene ACO leaders and
other experts to identify current capabilities and obstacles, helping generate potential
solutions and recommendations that will be published in a policy paper later this year.
It will then gather stakeholders, including CMS, the Office of the National Coordinator
for Health IT (ONC), and health IT vendors, to discuss and react to the policy
recommendations. The Task Force is chaired by Katherine Schneider, MD, past NAACOS board
chair.
CMS
MOVES TO LIMIT ADUHELM COVERAGE Following NAACOS’s
advocacy, CMS will limit coverage of monoclonal antibodies that target amyloid for
the treatment of Alzheimer’s disease to patients participating in qualifying clinical
trials. NAACOS urged CMS to finalize its proposed National Coverage Determination (NCD),
citing concerns that the expected costs of Aduhelm (aducanumab) would outweigh its
clinical benefits. NAACOS was supportive of the narrow proposed NCD until more
scientific evaluations exist to support the drug’s efficacy. The list price of $28,000
per person for a year of treatment is nearly two-and-one-half times the average ACO’s
benchmark.
NAACOS
ENHANCES RESOURCES TOUTING THE ACO MODEL As part of increased efforts
to spread awareness and understanding about ACOs and value-based care more broadly,
NAACOS has published a new “About ACOs” page as part of the NAACOS website. This public
webpage includes a description of ACOs, including what they are and the goals of
accountable care, resources on various ACO topics, information on key Medicare ACO
programs, and answers to frequently asked questions. NAACOS will continue to update this
page with additional resources and educational videos aimed at a general audience that
may not be familiar with the jargon of value-based care. These resources are intended to
be shared broadly, and NAACOS will use them in conversations with congressional staff,
patient advocacy groups, and other key stakeholders. We encourage ACOs to use these to
educate patients, their communities, and any other stakeholders who would benefit from
understanding the ACO model and the benefits it provides.
CMS
INDEFINITELY DELAYS RADIATION ONCOLOGY MODEL In a Federal Register notice published earlier this month, the CMS
Innovation Center is delaying until “a date to be determined through future rulemaking”
the start of the Radiation Oncology Model. The mandatory model would test bundled
payments for 90-day treatment episodes for certain types of cancers. It has already been
twice delayed by Congress. The Innovation Center’s Oncology Care Model is slated to end
on June 30 with no alternative yet announced either.
Welcome
New ACO Member
Bluestone
ACO Jacksonville,
FL
NAACOS
SUBMITS COMMENTS IN RESPONSE TO PTAC RFI Last week, NAACOS submitted comments to the Physician-Focused Payment Model Technical Advisory Committee
(PTAC) in response to a request for input (RFI) issued by the committee to solicit
feedback from stakeholders on issues related to the design and implementation of
population-based total cost of care (TCOC) models. This request is part of a broader effort by PTAC to give committee members information
about current perspectives on the role that population-based TCOC models can play in
optimizing health care delivery and value-based transformation in the context of
alternative payment models (APMs). NAACOS’ comments include information and
recommendations on a variety of factors that affect the success of population-based TCOC
models such as ACOs. Issue areas included payment structures and financial incentives,
care delivery strategies, health equity and clinical quality considerations, and
perspectives on provider readiness, participation incentives, and administrative burdens
associated with participation in a population-based TCOC model. Given CMS’s goal to have
all traditional Medicare beneficiaries in a care relationship with accountability for
quality and total cost by 2030, it will be important that TCOC models include an
appropriate balance of risk and reward to attract provider participation and sound
program fundamentals to ensure success and sustainability.
MEDPAC
HOLDS SESSION DISCUSSING APMS On April 8, the Medicare Payment Advisory
Commission (MedPAC) held a meeting to discuss an upcoming chapter in the June report
about ideas for streamlining and harmonizing Medicare’s portfolio of APMs. The
commission sees ACOs and population-based models as a building block for Medicare’s
APMs. Building off the commission’s 2021 recommendations for CMS to implement a more
harmonized portfolio of fewer APMs, commissioners favor a smaller number of tracks for
ACOs, along with eliminating the periodic “rebasing” of an ACO’s spending benchmark. The
commission also favors operating a national episode-based payment model concurrently
with ACOs. Under this type of model beneficiaries in an ACO would be concurrently
attributed to both models during the episode. NAACOS met with MedPAC staff in March to
discuss concerns about how mandatory episodes could negatively impact ACOs. NAACOS will
be closely following and summarizing the June report for our members.
CONGRESS
INTRODUCES SDOH LEGISLATION Last week, Senator Cory Booker (D-NJ) and Representative Terri Sewell (D-AL)
introduced the John Lewis Equality in Medicare and Medicaid Treatment (EMMT)
Act of 2022 that would require the CMS Innovation Center to work with experts to
consider health disparities when developing payment models. Under current law, the
Innovation Center is only required to consider a model’s ability to lower costs and
improve quality. This bicameral legislation would add a requirement for the Innovation
Center to also consider models’ potential to reduce health disparities. In addition, it
includes requirements for the Innovation Center to consult experts in health disparities
and social determinants of health on developing new payment models that focus not only
on lowering costs but also advancing health equity and improving access to care, to
include those experts during the evaluation of new payment models, and to create a
Social Determinants of Health Model that tests payment and delivery innovations to
address behavioral health services, dual-eligible beneficiaries, and maternal mortality.
Innovation Center Director Liz Fowler has stated the intention “to consider health equity
at every stage of our models, from model development to participant recruitment through
model evaluation,” and NAACOS has offered several recommendations to the Innovation Center on strategies to
advance health equity through ACOs.
WHITE
HOUSE RELEASES EQUITY ACTION PLAN ACROSS FEDERAL AGENCIES Earlier this
month, the White House released the first Equity Action Plans across more than 90 federal agencies, as
called for in President Biden’s Executive Order on Advancing Racial Equity and
Support for Underserve Communities Through the Federal Government. The HHS Equity Action Plan includes six new strategies to advance
health equity. These strategies focus on maternal mortality, language access issues in
health care, incorporating equity into grants, implementing equity assessments across
the department’s policies and programs, investing resources to advance civil rights, and
expanding contract opportunities for small, disadvantaged businesses. Other departments’
equity action
plans that include health equity elements are the Department of Veterans
Affairs, the Department of Agriculture, and the Office of Personnel Management. NAACOS
will continue to monitor the administration’s efforts to advance equity and share
relevant information with members. To learn more about NAACOS’ ongoing work to support
ACOs’ ability to address health equity, visit our health equity page.
LAST
CHANCE TO JOIN SPECIALIST LEARNING LAB ON APRIL 27 The in-person
kickoff for NAACOS Inaugural Learning Lab will occur in less than a week in Baltimore.
If you would like to join us for this in-person brainstorming and project mapping
session focused on ACO needs to integrate and engage specialty providers in their
networks, SIGN UP NOW to assure you receive the meeting materials. The
kickoff will be followed by monthly virtual sessions to continue the conversations and
work toward creating ACO resources on specialist integration and engagement.
The NAACOS Learning Lab is designed to provide a deep dive into fundamental
strategies in accountable care and to foster exchange among peers with frontline
experience. To attend the Learning Lab, ACO members can register at no cost for
participation. We are limiting participation to one person per organization for this
in-person event. Additional staff may participate in follow up lab activities held
virtually in the coming months.
If a representative from your ACO has
expertise to present or would like to take a more active role in the lab’s ongoing
activities, please reach out to Melody Danko-Holsomback, NAACOS Vice President of
Education, mdholsomback@naacos.com.
And don’t forget to Register Today to join us in Baltimore.
NAACOS
HOSTING A WEBINAR ON MSSP BENCHMARK REPORTS Join us May 3, 2022, at
2:00 pm ET as NAACOS hosts Mercy ACO and Milliman as they take a first-hand look at the
MSSP preliminary benchmark reports. Mike Sarli from Mercy ACO will present on the ACO’s
2022 renewal experiences, as Milliman provides the expertise and support on what these
and future reports may mean for your ACO in the coming year. Sign up now to join us for this event!
