NAACOS AND OTHERS URGE CMS TO INNOVATE PRIMARY CARE PAYMENT IN MSSP
This week, NAACOS and more than 20 organizations sent a
letter to CMS leadership encouraging the agency to develop and
implement an optional payment approach within the Medicare Shared Savings Program (MSSP) that would provide partially capitated payments for primary care services. NAACOS has been engaged in
conversations with our members, other stakeholder groups, and CMS staff to further develop and refine this proposal.
READ OUR BLOG: COVID-19 IMPACT ON REACH BENCHMARKS
Inclusion of years affected by the COVID-19 pandemic in ACO REACH benchmarks will create unfair performance standards because of data anomalies. For more information,
read our new blog by NAACOS and ACO member
Physicians of Southwest Washington (PSW) and MultiCare Connected Care in Olympia, Washington. If you have suggestions for issues to
highlight in our blog, please reach out to advocacy@naacos.com.
SHARE YOUR PATIENT SUCCESS STORIES
As part of our efforts to promote value-based care, NAACOS is collecting ACO success stories. We are looking for stories that highlight the positive impacts ACOs have on their patients and
communities. We will use these stories in our advocacy and public relations. Please share key details and a brief
summary of your story. NAACOS will follow up for additional information prior to using any of the information submitted.
Welcome New Business Partners
SHARE YOUR QUESTIONS FOR CMS PRIOR TO TOWN HALL
NAACOS will host CMS and Innovation Center officials at our spring conference Town Hall on Friday, May 5 at 1:15 pm. The session will allow ACOs to engage in an open dialogue with CMS about
important administration priorities. Please send any questions you have in advance by emailing advocacy@naacos.com.
CONGRESSIONAL UPDATES
LAWMAKERS FOCUS ON HHS BUDGET AND HEALTH CARE COSTS
Health and Human Services (HHS) Secretary Xavier Beccera is making the rounds on Capitol Hill testifying before lawmakers regarding the President’s Fiscal Year 2024 health spending and policy
priorities. The President’s budget submission is the first step in the congressional appropriations process.
The House and Senate Appropriations Committees are currently accepting funding requests from stakeholders, holding hearings with administration officials, and will begin drafting and
introducing spending bills in the coming months.
The House Ways and Means and Energy and Commerce Committees are also holding hearings focusing on health care costs. The hearings will highlight the impact of inflation on health care
costs and examine transparency and competition in health care.
The committees have also expressed interest in holding hearings later in the year to discuss improvements to the Medicare payment system.
WHITE HOUSE BUDGET INCLUDES ADMINISTRATION’S HEALTH PRIORITIES
On March 9, the White House released the President’s Fiscal Year 2024 budget request. The HHS budget is
available online. While presidential budgets are aspirational and spending bills must be approved by Congress,
the budget does highlight the administration’s top spending and policy priorities.
The HHS budget in brief includes:
Highlights of the administration’s support for MSSP and ACO REACH, including an overview of key policy changes approved by CMS and the Innovation Center to improve the programs.
An outline of several legislative proposals to improve the Quality Payment Program (QPP), allow collection of social determinants information through CMS quality programs, implement
targeted risk-adjustment payment review in Medicare Advantage (MA), and establish new medical loss ratio requirements for supplemental Medicare benefits.
ADMINISTRATION UPDATES
2021 ACO UPDATES ON CARE COMPARE
The Care Compare website now includes information on
ACO quality measure performance for 2021. CMS is required to report certain clinician and ACO quality performance data, displayed using measure-level star ratings, percent performance scores,
and checkmarks. More information on the data provided on ACOs is outlined in this
CMS resource. If you have any discrepancies in data to report to CMS, contact the
Quality Payment Program at QPP@cms.hhs.gov.
CONTINUED IMPLEMENTATION OF THE INFLATION REDUCTION ACT
The Biden-Harris administration took two separate steps on its agenda to lower drug prices.
CMS announced it would
fine drugmakers for increasing the price of 27 Part B drugs faster than the rate of inflation. The rebate program is meant to stop the sharp increase in drug prices. The 27 drugs are
spelled out on this CMS document. CMS will make affected
providers whole by paying the difference between the full
and reduced beneficiary co-pay after the adjustments.
CMS published guidance detailing requirements and
procedures for implementing a program that allows Medicare to negotiate the price of drugs with manufacturers. CMS will publish the names of the first 10 drugs selected for negotiation
by September 1, 2023, with prices will taking effect in 2026. The number of drugs negotiated will increase up to 140 by 2033. Part B drugs will be eligible for negotiation by 2028.
Comments on the guidance are due April 14 with a revised document expected this summer. A
fact sheet on the guidance is available online.
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.
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.
COMPLIANCE WEBINAR RECORDING
Last week Kimberly Busenbark shared the keys to implementing compliance programs for MSSP and REACH ACOs.
View the recording and access the slides from last week’s presentations. Start a discussion on MSSP or REACH compliance
programs via NAACOS Listserv. Purchase your
Compliance Manual subscription today!
A WORLD OF SOLUTIONS FOR ACOS, ALL IN ONE MARKETPLACE
Our marketplace is a one-stop shop for ACOs to access a wide range of products and services from trusted partners. The marketplace provides access to various partners that can help your ACO
achieve organizational goals through innovative and cost-effective solutions.
Visit the NAACOS marketplace.
EDUCATIONAL EVENTS
MEENA SESHAMANI TO OPEN THE SPRING 2023 CONFERENCE Join us May 3-5, 2023, for the NAACOS Spring Conference at the Hilton Baltimore Inner Harbor. Meena Seshamani,
director of the Center for Medicare, CMS, will open the conference followed by a roundtable discussion, APMs vs. MA: Opportunities and Challenges to Achieve Savings and Innovate Care across
Models led by Emily Brower of Trinity Health. 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. Register NOW!
EARLY REGISTRATION DEADLINE EXTENDED THROUGH THIS FRIDAY AT 5:00 PM ET!
Register before Friday, March 24 at 5:00 pm ET for the in-person conference and receive a discount of $300 per person. Can’t attend in-person? Register for our
live webcast before March 24 at 5:00 pm ET and receive a discount of $100 per person.
Register NOW!
**GROUP RATES** Take advantage of our group rates for both the in-person and virtual
conference. Rates will increase after March 24 at 5:00 pm ET. To register at the group rate, please contact
Emily Perron.
Exhibitor and sponsor opportunities are still available! The conference will feature exhibitors with products and services specifically for the accountable care community.
Partners reserve your space today!
APRIL’S MEDICAID LEARNING LAB ON HOME CARE FOR DISABLED Join the Medicaid Learning Lab monthly series that will run through December 2023. The virtual meetings in this series began
December 2, 2022, and will continue in monthly 90-minute sessions through December 2023. These monthly meetings occur 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
highlight 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.
DISCOVERY CALL FOR ARCADIA USERS
As requested by our ACO members, NAACOS will hold a discovery call for ACO members using the Arcadia product to learn from one another. This call will take place on March 30 from 2:00 to 3:00
pm ET. After some brief presentations by ACO members on how they are utilizing the platform, there will be an open discussion.
Sign Up to attend this event.
WEBINAR: UTILZING MSSP FILES AND THE CMS BENCHMARK ESTIMATOR TOOL
NAACOS will host a webinar on April 19 from 12:30 pm to 1:30 pm ET to provide an overview of the information found in the MSSP 4th Quarter Files and how to utilize them along with the CMS
benchmark estimator tool to obtain 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, about how
Nebraska Health Network utilized these files to not only predict yearly outcomes but also to define clinical improvement.
Register today to add this event to your calendar.
WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE
The Medicare Payment Advisory Commission (MedPAC) released its
March 2023 Report to Congress. The commission recommended
slight updates for hospital and physician payments, while calling for flat updates or cuts for post-acute care providers. The report also continued to express concern with MA costs
compared to fee-for-service and highlighted the commission’s prior recommendations to reform MA risk coding and quality bonus programs.
Republicans on the Senate Finance Committee sent a letter to the
Biden administration expressing concern about the proposed timeline for changes to MA risk adjustment policies.
The Congressional Budget Office (CBO) responded to a request from the Senate Budget Committee and
released information showing that it overestimated mandatory spending for health care over the last 10 years.
