JOIN
NAACOS TO DISCUSS DIRECT CONTRACTING AND ACO REACH NAACOS monthly
Direct Contracting Learning Discussion is a forum for shared learning, and we encourage
you to join us and raise questions, share your experiences, and react to issues. The
next meeting is August 19 from 12:00 – 1:00 pm ET. We will discuss the recent release of
the ACO REACH financial methodology, among other issues. Advance registration is required. Please share any questions or
discussion topics in advance by emailing directcontracting@naacos.com.
In addition, you are encouraged to join the ACO REACH Financial Methodology
Webinar on August 23; registration is free for NAACOS members and business partners.
The deadline for deciding between ACO REACH and MSSP is September 9. The webinar will
review the financial methodology and provide an actuarial comparison between MSSP and
REACH.
NAACOS
RESPONDS TO HHS PRIMARY CARE RFI Last week, NAACOS submitted feedback in response to a Department of Health
and Human Services (HHS) Request for Information (RFI) on strategies to strengthen
primary care. The RFI is part of the HHS Initiative to Strengthen Primary Health Care.
In comments, NAACOS highlighted the ACO model as a key lever to strengthen primary care
and recommended several policies that would enable ACOs to advance primary care
innovation and transformation.
NAACOS
LAUNCHES MONTHLY GOVERNMENT RELATIONS ADVOCACY CALLS For the remainder
of the year, we are focused on advancing the Value Act and getting Congress to extend
the Advanced Alternative Payment Model (APM) incentive payments. To ensure that we are
closely aligned with your government relations teams, NAACOS will be holding monthly
calls for your in-house or contracted government relations teams. These calls will be an
informal forum for sharing updates on congressional outreach and materials that can be
used in congressional meetings. The calls are scheduled for 2:00 pm ET on the third
Thursday of each month. The next call is scheduled for August 18. Contact Aisha Pittman and Robert Daley to have your organization’s
in-house or external government relations team join.
Welcome
New Business Partners
1upHealth At
1upHealth we’re connecting an ecosystem of payers, providers,
patients, life sciences and app developers within a trusted
interoperability network. Our fully cloud-based and purpose-built
platform is built to deliver broad-scale interoperability across a
patient-mediated network of over 10,000 clinical endpoints –
allowing for greater ease and efficiency to improve patient
outcomes, drive population-level analytics and enable medical
innovation. 1up.health
Electronic
Caregiver Inc. ECG
offers flexible options for health network integration,
implementation support and promotes the most robust privacy and
security protocols available. ECG’s enterprise platform and services
are HIPAA compliant, rigorously tested and certified by an AWS Well
Architected Review. electroniccaregiver.com
Quality
Reviews Quality
Reviews, also known as Q Reviews, helps healthcare organizations to
increase patient and member engagement throughout their care
journey. With a suite of digital solutions, providers and payers can
deliver a digital experience with safer, empathetic, and actionable
instructions. q-reviews.com
CONGRESSIONAL
UPDATES
SENATE
PASSES INFLATION REDUCTION ACT On August 7, the Senate passed the
Inflation Reduction Act (IRA) by a vote of 51 to 50, with Vice President Kamala Harris
casting the tie-breaking vote. The bill is expected to be voted on and passed in the
House of Representatives on August 12 and then proceed to the White House for President
Biden’s signature. In addition to climate, energy, and tax measures, the bill includes
several healthcare provisions:
Drug Pricing. The bill would create (1) a Medicare drug pricing negotiation
program for certain high price pharmaceuticals, (2) rebates for Medicare Part B
or D drugs when prices increase faster than inflation, and (3) lower
out-of-pocket thresholds and a new manufacturer discount program for certain
Medicare Part D drugs.
Affordable Care Act (ACA) premium subsidies. The bill would extend federal
subsidies for an additional three years through 2025. Of note, this extension is
a year longer than originally proposed, placing the issue effectively
“off-the-table” until a year after the 2024 Presidential Election.
With consideration of the IRA nearly complete, lawmakers will recess. Upon return to
Washington in September, lawmakers will begin laying out priorities that need to be
addressed before the end of the year. NAACOS has been working with our stakeholder
partners asking Congress to prioritize an extension of the 5 percent Advanced APM bonus.
SENATE
APPROPRIATIONS COMMITTEE RELEASES FY 2023 FUNDING BILLS The Senate
Appropriations Committee released a package of Fiscal Year (FY) 2023 funding bills. The
package includes funding for HHS, CMS, and $21 billion in emergency supplemental funding
for COVID-19. Democratic and Republican leaders in the House and Senate will need to
reach a bipartisan agreement in the coming weeks to extend government funding past the
end of the fiscal year, which ends on September 30.
HOUSE
CONSIDERS TELEHEALTH EXTENSION AND MA PRIOR AUTHORIZATION On July 27,
the House passed legislation to extend Medicare’s COVID-19 telehealth waivers for two
additional years until 2024. This includes waivers for originating site requirements,
audio-only telehealth, and an expanded list of telehealth practitioners. The bill would
also allow for qualified health centers and rural health clinics to be reimbursed for
telehealth services. Committee leaders have said Congress needs more time to study and
examine current telehealth flexibilities before lawmakers consider a permanent
expansion. The bill now moves to the Senate where it’s likely to be amended before
further consideration later in the year.
The House Ways and Means Committee
recently approved Rep. Suzan DelBene’s (D-WA) bipartisan bill to reform the Medicare
Advantage (MA) prior authorization process. Specifically, the bill would require MA
plans to adopt electronic prior authorization process, provide real-time decisions for
routinely approved items and services, and publish information on approval rates and
response time. The bill is now cleared to be considered by the full House of
Representatives following the August Recess.
ADMINISTRATION
UPDATES
ACO
REACH FINANCIAL PAPERS PUBLISHED The CMS Innovation Center has
published financial methodology papers for the ACO
REACH Model. The papers are broken out by topic and include an overview, capitation, risk adjustment, the rate book, and settlements. There are few changes beyond the Global and
Professional Direct Contracting (GPDC) Model and previously announced changes such as
the health equity benchmark adjustment. Join the NAACOS webinar on the differences between REACH and
MSSP on August 23 and read our summary of the REACH financial methodology.
CMS
REQUESTS FEEDBACK ON MA CMS released a request for information seeking feedback on aspects of the MA
program. The agency seeks input on improving health equity, access to care,
affordability, and how MA plans work with ACOs. NAACOS previously provided input on how MA plans work with ACOs in response to the
annual MA call letter. If you have feedback for NAACOS on how your ACO works with MA
plans, please email advocacy@naacos.com.
CMS
PUBLISHES FINAL PAYMENT RULES On August 1, CMS issued the FY 2023
Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long‑Term Care
Hospital (LTCH) Prospective Payment System (PPS) final rule. Of note, CMS finalized:
A 4.3 percent increase in hospital payments for FY 2023,
A 5 percent cap on any wage index decreased, and
Three new health equity measures that hospitals will be required to report in
the coming years: Hospital Commitment to Health Equity, Screening for Social
Drivers of Health, and Screen Positive Rate for Social Drivers of Health.
CMS also released final rules for other payment systems:
Skilled Nursing Facilities (SNFs) will receive a 2.7
percent increase. This is a departure from the original proposal to decrease
payments. CMS also expanded the measures used in the SNF value-based purchasing
program and capped wage index decreases at 5 percent.
CMS
POSTS 2020 QPP EXPERIENCE REPORTS CMS recently released the 2020
Quality Payment Program Experience Report, summarizing performance in the Merit-Based
Incentive Payment System (MIPS) and providing information on Qualifying APM Participants
(QPs). Highlights include:
Clinicians participating in APM Entities earned the highest average final MIPS
scores for 2020.
Average scores for APM Entities increased from 2019 to 2020 (92.76 in
2019 to 96.24 in 2020).
MSSP accounted for 92 percent of MIPS APM participants.
90.9 percent of MIPS eligible clinicians received a positive MIPS payment
adjustment.
While performance threshold increased, the Public Health Emergency (PHE)
policies in effect at that time contributed to performance.
Less than 2 percent of all MIPS eligible clinicians received penalties.
The number of clinicians who achieved QP status increased by 40,000; 235,225
achieved QP status.
MSSP ACOs average QP threshold scores were 49 percent for payment and 50 percent
for patient counts. QP thresholds are scheduled to increase to 75 percent for
payments and 50 percent for patients in 2023. NAACOS has been advocating
Congress to extend the 5 percent Advanced APM bonus and give CMS authority to
set more reasonable QP thresholds.
CMS
HIGHLIGHTS LESSONS FROM AHC MODEL In a recent blog, CMS shared key lessons from the Accountable
Health Communities (AHC) Model. The models recently concluded in April and
focused on evaluating health-related social needs (HRSN) screening, referral, and
navigation. CMS noted how it has incorporated successful elements of the program into
other models, including ACO REACH and advance incentive payments in MSSP.
WHAT
WE’RE WATCHING
REPORT
EXAMINES INTERSECTION OF DATA SHARING AND VALUE-BASED CARE An Urban Institute report funded by HHS recommends greater
financial incentives to support the sharing and integration of clinical and population
health data into ACOs. The goal was to identify ways to improve data sharing and
integration to help advance value-based care. The report was informed by interviews with
21 organizations.
EDUCATIONAL
OPPORTUNITIES
CAN’T
ATTEND FALL CONFERENCE IN PERSON? REGISTER NOW FOR LIVE WEBCAST! Join
us September 8–9 for the NAACOS Fall 2022 Conference with optional half-day workshops on
September 7. The agenda features leading ACO experts and CMS officials sharing timely
and essential information for ACOs.
Individuals unable to attend the
conference in person can participate in the live webcast that includes all 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. Register Now!
As always, it’s
never too late to attend in person at the Marriott Marquis Washington, D.C. Take
advantage of our group rates for both the in-person and virtual conference. To register
at the group rate, please contact Emily Perron.
Exhibitor
and Sponsor opportunities are still available! The NAACOS Fall
Conference will feature exhibitors with products and services specifically for the
accountable care community. Reserve your space today!
Welcome
New ACO Member
Wellstar
Clinical Partners Medicare ACO, LLC Marietta,
GA
MSSP
REPAYMENT MECHANISM SUBMISSION DATE FAST APPROACHING With the MSSP
repayment mechanism date of September 9 fast approaching, join the upcoming NAACOS
webinar, Understanding the Mechanics of the MSSP Repayment Mechanism, on August 15 from
3:00–4:00 pm ET to prepare for submission. This webinar is aimed at ACOs going into or
increasing their risk tracks and will help you prepare your repayment mechanism
documents and submit them. The webinar will feature two ACO leaders who have worked
through these processes and can provide valuable information on best practices to
successfully obtain and submit your repayment documents. The webinar will include
information on each of the options, why you may choose one method over another, and how
to obtain and submit the needed documentation. We will also review the calculations CMS
uses to determine the required amounts so that you can estimate the amount for your ACO.
Register today to join this event!
IN-PERSON
LEARNING LABS COMING ON SEPTEMBER 7 Join us in Washington, D.C., on
September 7 from 1:00–5:00 pm ET for two NAACOS Learning Labs: the kick-off of our new
Medicaid Learning Lab and the continuation of Specialist Integration and Incentives.
As interest grows in how ACOs can participate and be successful in
Medicaid, NAACOS is hosting its newest Learning Lab to prepare ACOs for Medicaid
contracts. Register
now to join the Medicaid Learning Lab kick-off in-person or future virtual
sessions. If you are unable to attend the first in-person session but want to be
included in future virtual sessions, first sign up then send a follow-up email to Emily
Perron.
For participants in the Specialist Integration and
Incentives Learning Lab, please email Emily
Perron if you plan to attend the in-person meeting on September 7. This meeting
will pull together information addressed to date in our two subgroups, update the full
group, and gather feedback for next steps.
Please note these are two
separate meetings that will take place at the same time as the NAACOS preconference
workshops. There is no charge for NAACOS ACO members to attend Learning Lab sessions.
As always, if a representative from your ACO has expertise to present or
would like to take a more active role in either of the learning labs, please reach out
to Melody
Danko-Holsomback, VP of Education.
DATA
UPDATES
ACO
QUALITY AND HEALTHCARE DISPARITIES The Institute for Accountable Care,
a non-profit research affiliate of NAACOS, is conducting a study of quality in MSSP
ACOs, including healthcare disparities among African American, LatinX and Asian/Pacific
Islander Medicare beneficiaries. Early results suggest that there is a sub-set of ACOs
that excel at addressing disparities in access, care for chronic conditions, and
avoidance of acute exacerbations. We are interested in learning more from the leaders in
the field: How do you build health equity into your strategic priorities? What care
redesign activities support access and patient-centered care? How do you engage
clinicians and beneficiaries in this work? If you are interested in sharing your story
with IAC/NAACOS and other ACOs, please reach out – we’d love to set up a call to learn
about your ACO and share the findings with other ACOs. Contact Jennifer
Perloff, perloff@brandeis.edu and Sam Sobul.
AWV
STUDY Are you using annual wellness visits (AWVs) effectively and for
high need, complex older adults? Are you using other evidence-based geriatric
interventions in your practice? Could you benefit from a structured AWV protocol? If you
answered yes to any of these questions, you may be interested in a new PCORI proposal on
the effectiveness of AWVs compared to AWVs enhanced with the GRACE model. Participating
ACOs will get access to an AWV protocol as well as training and support in the GRACE
model, including access to dozens of standardized protocols that can be implemented with
older adults needing support with a range of geriatric issues. If you are interested in
learning more, please reach out to Jennifer
Perloff, perloff@brandeis.edu and Sam Sobul
from the Institute for Accountable Care. Thanks!
