2023 PRIORITIES AND TRENDS UPDATE
Last year the ACO community had numerous wins with favorable updates to the Medicare Shared Savings Program (MSSP), opportunities to join the revised ACO REACH model, and a one-year extension
of advanced APM incentive payments at 3.5 percent. This year will be another crucial year for value-based care as Congress confronts misaligned incentives for moving to value and the Biden
administration enters a third year of continuing progress towards the goal of every Medicare patient in an accountable care relationship by 2030. As the COVID-19 Public Health Emergency (PHE)
begins to unwind and the health care industry faces both rising health care costs and shrinking reimbursement, advocacy will be critical to supporting the work of ACOs. NAACOS stands ready to
advocate for policies that support value-based care; here is a list of our top advocacy issues in 2023.
Advance Legislation that Continues to Incent the Movement to Value. A bipartisan group of lawmakers are looking to update and improve the Medicare Access and CHIP
Reauthorization Act (MACRA) to make the Medicare payment system more efficient and sustainable via the transition to value-based care. NAACOS looks forward to working with these
lawmakers on legislative proposals that:
Extend incentive payments for new and existing advanced alternative payment models (APMs) and give CMS the authority to set qualification thresholds based on current model
participation.
Reform the Merit–Based Incentive Payment System (MIPS) to encourage APM adoption by removing duplication on quality measures, reestablishing the MIPS high-performance bonus
program, and reducing administrative burdens.
Reform the Center for Medicare and Medicaid Innovation’s (CMMI) evaluation process to encourage the development of more APMs.
Seek better parity between Medicare Advantage (MA) and ACOs by requesting a study on benchmarks and encouraging MA to develop risk-based arrangements with providers.
Advancing legislation will require significant engagement with our existing champions and building new congressional champions. Our engagement plans include:
A public relations campaign on the value of value. NAACOS helped launch the Alliance for Value-Based Patient Care last year with the goal of supporting ACOs through a
well-coordinated public relations and advertising campaign. That work will broaden in 2023.
Engaging with lawmakers through campaign donations from the NAACOS Action Fund. Please reach out if you would like to learn more about our political action committee.
Strengthening our congressional outreach through virtual and in-person meetings. Please encourage your internal or external government relations team to join our Government
Relations Advocacy Call held the third Thursday of each month at 2:00 pm ET.
Ensure Member Success in MSSP and ACO REACH. NAACOS will continue to work to remove burden and improve the existing ACO programs. Specifically, we will advocate for:
A better glidepath for the transition to electronic Clinical Quality Measures (eCQMs) for ACOs. NAACOS will continue to advocate for an extension of
the Web Interface platform while challenges with eCQMs and digital measures are addressed.
Improvements to the ACO REACH model. With 2023 as the first year of REACH we will work with members to determine what’s working best and where there
are opportunities to improve the program.
Benchmarking. CMS has indicated that it is beginning work to consider benchmarks for the long-term success of the ACO program. NAACOS will work with
CMS to ensure that the “ratchet effect” and other challenges in benchmarks (e.g., risk adjustment) are addressed through changes to existing benchmarks and the development of
administrative benchmarks.
Bring New Innovation to the MSSP. As the only permanent ACO program, MSSP can serve as a permanent home for innovation tested through other CMMI models. Two
opportunities for building innovation into MSSP include:
Enhanced Plus, a full-risk track with additional flexibilities and
Optional primary care capitation.
Seek policies that will ensure the long-term success of ACOs and providers participating in ACOs, including:
Define strategies for increasing specialist engagement in ACOs. NAACOS will seek to influence the implementation of CMMI’s specialty engagement
strategy.
Identify opportunities to increase flexibilities for ACOs at the conclusion of the public health emergency.
Determine ACOs’ role in ongoing and emerging topics, such as leveraging health IT to improve value-based care and demonstrating how ACOs can help
support drug pricing reform.
Expand ACO Arrangements with Other Payers. NAACOS will work to understand best practices for deploying ACO arrangements with other payers and identify opportunities to
encourage greater adoption. Congressional and administration interest in reviewing overpayments in Medicare Advantage (MA) creates an opportunity to seek parity with MA (e.g., similar
flexibilities to innovate care) and create incentives for MA plans to enter value-arrangements with providers.
Engage Patients and Leveraging Patient Stories to Support Advocacy. CMS continues to explore improved strategies for engaging patients in primary care and educating
patients about value-based care. NAACOS has launched a member workgroup to inform a broad patient engagement strategy, identify best practices and research needs, and develop
strategies to support members in educating patients about the benefits of ACOs.
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ACO REACH LEARNING DISCUSSION TO FOCUS ON HEALTH EQUITY
NAACOS’s first ACO REACH Learning Discussion of the year will take place January 20 from 12:00–1:00 pm ET. We will discuss the model’s health equity requirements, focusing on (1) the Health
Equity Plan; (2) the Health Equity Benchmark Adjustment; and (3) demographic and social determinants of health data reporting requirements. Participation is limited to those participating in
ACO REACH, and advanced registration is required. If you have questions or
additional topics you want discussed, please share them in advance by emailing acoreach@naacos.com.
NAACOS SUBMITTING COMMENTS IN RESPONSE TO SENATE RFI
This week, NAACOS is submitting comments in response to a request for information issued by
six senators
seeking feedback on strategies to improve care and control health care spending for beneficiaries dually eligible for Medicare and Medicaid. In this response, NAACOS recommends leveraging the
ACO model to create a financially and clinically integrated system of care for duals. Comments are due this Friday, January 13 and can be submitted to
dualeligibles@cassidy.senate.gov.
CONGRESSIONAL UPDATES
NEW CONGRESS ARRIVES IN WASHINGTON
The 118th Congress convened on January 3. Newly elected members of the House and Senate have been sworn in. The Senate is currently in a state work period and will return to Washington to
begin legislative business on January 23. Last week, House members began casting votes for Speaker of the House. After initially failing to secure the required votes, Rep. Kevin McCarthy
(R-CA) was elected as speaker. On January 9, the House also approved a rules package that makes significant changes to how the chamber will conduct business for the next two years. The new
rules package requires that any legislation increasing mandatory government spending be offset with equal or greater cuts to spending. Tax increases will not be permitted as an offset. The
House Republican Steering Committee also met this week to select new chairs for several key committees. Rep. Jason Smith (R-MO) was selected to serve as the chairman of the House Ways and
Means Committee, which has jurisdiction over health and Medicare programs. Rep. Jodey Arrington (R-TX) was selected to chair the House Budget Committee. With committee chairs and the new rules
package in place, the House will begin moving forward on legislative business.
ADMINISTRATION UPDATES
COVID-19 PHE EXTENDED INTO APRIL
As expected, HHS Secretary Xavier Becerra renewed the COVID-19 Public Health Emergency, which will now
extend until April 11. A number of Medicare policies are tied to the PHE, including CMS waiving shared losses for MSSP ACOs, removing COVID-19 treatment episodes from performance year
expenditures, and broad application of telehealth waivers. More information is available on the NAACOS COVID-19 page.
DON’T MISS OUR WEBINAR—QUALITY REPORTING TIPS FROM ACOS
The Performance Year (PY) 2022 quality reporting window is now open and closes March 31, 2023. Join us for our webinar in which ACOs will share their tips and tricks to quality reporting
success with the Web Interface and eCQMs. The webinar will also review key quality policies for ACOs and review resources to assist ACOs in reporting for MSSP. The webinar will be held on
February 1 from 2:00–3:00 pm ET. Register Now!
NEW 2023 MIPS, QUALITY RESOURCES AVAILABLE
CMS has shared several new resources for 2023 MIPS and ACO quality measure specifications. Access the 2023 resources on the
QPP Resource Library and search by title:
2023 CMS Web Interface Measure Specifications and Supporting Documents
As a reminder, these resources explain specifications and other measure information for PY 2023 quality and MIPS. ACOs should refer to 2022 specifications to report measures for PY 2022; the
PY 2022 reporting process is currently underway and closes March 31, 2023.
NEW CMS RESOURCES ON VALUE
CMMI released performance results for the first year of the End Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. Most participants improved their home dialysis and transplant
rates and were awarded either a 0 percent or 2 percent increase on their claims due to performance. More information is on the
model website or this
one-pager.
CMS issued new guidance for states on addressing social determinants of health
(SDOH) and reducing disparities through Medicaid managed care plans. States with approved managed care plans can use In Lieu Of Services and Settings (ILOSs) to address the
health-related social needs of Medicaid beneficiaries while also ensuring the effective and efficient use of Medicaid resources.
EDUCATION OPPORTUNITIES
DISCOVERY CALLS ON HCC GAPS AND END OF LIFE DOCUMENTATION
Due to popularity on the NAACOS Executive ListServ, we have the following discovery calls scheduled for January. These discovery calls are very informal with one or two brief presentations
from ACOs followed by an open forum for discussion. This platform allows ACOs to connect with others who are working on the same types of initiatives to gather experience and achieve better
outcomes.
Join us on the topic of HCC Gap and Documentation Efforts on January 18 from 3:00–4:00 pm ET for a
discussion led by Harry Reese and Cale Browning from Ochsner. Harry and Cale will open the discussion by sharing the work they are currently doing in this area. There will be time for
questions and others to provide their work and perspectives.
End of Life Documentation Efforts will be held on January 31 from 3:00–4:00 pm ET. Dr. Nathan Moore from BJM will review BJM’s efforts in this space. ACOs can use this
opportunity to listen to his presentation, add to the information from their own experience, and ask questions.
Sign-up to join this discovery call.
In addition, NAACOS will post the recording for the Discovery Call on Epic Claims Ingestion Process that was held on January 11 on our new
Discovery Call page.
VIRTUAL AFFINITY GROUP MEETINGS RESUME JANUARY 26
These virtual peer-to-peer opportunities are offered to NAACOS members throughout the year in addition to the in-person sessions at our spring and fall conferences. Like the conference
sessions, these virtual meetings provide peers in similar positions in a value-based care setting with a forum to meet and discuss hot topics, network, and exchange ideas.
The meeting link will be provided in the confirmation e-mail when you sign up for each group, and it will work for all future meetings. You may sign up for as many groups as
you are interested in. NAACOS ACO members who have not yet signed up can register for NAACOS Affinity Groups via the links below.
Executive Affinity Group: meets virtually on February 23, July 25, and November 21 from 3:00–4:00 pm ET
Clinical Affinity Group: meets virtually on March 2, August 1, and November 28 from 3:00–4:00 pm ET
JUST A FEW SEATS REMAIN FOR THE WINTER 2023 BOOT CAMP
Join us at the Marriott Orlando Airport Lakeside on February 9–10 for the Winter Boot Camp. The boot camp
will provide expert insight into the core competencies for ACOs. Faculty from top-performing ACOs, including Baylor Scott & White, Geisinger Health, Trinity Health, ChristianaCare, and
NOMS, will present clinical and operational strategies for success in any value-based care model. Participants will learn about clinical improvement models, their outcomes, and implementation
tips and tricks. The format will include presentations by clinical and operational leaders in accountable care, along with case studies and peer-to-peer learning.
Full agenda is now available!
**This boot camp will only be offered for in person. There is no virtual option. Boot camps are not open to business partners. Space is limited to 100 people.**
TOPICS ANNOUNCED FOR SPRING 2023 CONFERENCE
Join us May 3–5 for the NAACOS Spring Conference at the Hilton Baltimore Inner Harbor. In addition to plenaries with CMS officials and other value-based care leaders, 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. Virtual and in-person registration options are available and, as always, the entire conference will be recorded.
Register early and save! Register before March 17 for the in-person or virtual conference and receive a discount.
Exhibitor and sponsor opportunities are now available! The conference will feature exhibitors with products and services specifically for the accountable care community.
Partners reserve your space today!
INSTITUTE UPDATE
WORKING WITH ACOS TO ADDRESS SOCIAL DRIVERS OF HEALTH
The Institute for Accountable Care recently completed a learning collaborative to help ACOs develop
strategies for addressing social determinants of health. The collaborative was co-led by staff from the Mount Sinai Health System and included 14 ACO participants. A summary of lessons learned
during the collaborative was
published Tuesday in Health Affairs Forefront. The collaborative
covered screening for SDOH, building
community partnerships, establishing
closed-loop referral processes, partnering with payers,
and key policy issues. The Health Affairs paper discusses the costs and complexity of developing effective screening programs and building referral networks, describes one-stop-shop Community
Resource Hubs, and makes recommendations on policies to support these activities.
WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE
The Medicare Payment Advisory Commission (MedPAC) will hold public meetings on January 12 and 13. The
commission will review and vote on draft recommended payment updates for Medicare’s payment systems. The commission will also discuss Medicare Advantage and Part D reports, behavioral
health, telehealth, and Part B drug costs.
