AGENDA
ANNOUNCED FOR JUNE BOOT CAMP ON DATA Everything ACOs 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.
Breakout sessions include:
ACO Data Sources and Uses in Population Health Practice Transformation
Explore Best Practices for Creating Actionable Dashboards and Reports
Assessing Year over Year Population Trends Using Claims and EMR Data
Creating Dashboards to Support Participant Needs
Considerations When Building Episodes Within ACO Data
Risk Calculations in Monthly Claims Analysis and Comparison
Risk Calculations in Benchmark Trending
Bring Your Data to Work Through Benchmark Predicting
Explain Claims Data Variation and How to Create Accurate Network Reports for
Acute and Post-Acute Settings
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!
Welcome
New Business Partners
Cedar
Gate Technologies Cedar
Gate enables payers, providers, employers, and service
administrators to excel at value-based care. Our unified technology
and services platform enhances and automates data management
activities to deliver employer and provider analytics, care
management, and payment technology necessary to pursue every payment
model and optimize performance in all lines of business. We
specialize in using prescriptive analytics powered by big data and
big math to make data think and find hidden patterns and unknown
correlations that lead to improved outcomes and lower costs. cedargate.com
Proficient
Health Proficient
Health is a healthcare IT company specializing in the secure
exchange of private data. Our online services connect physicians,
hospitals and other healthcare providers – helping them easily
capture and share information, improve service and care delivery,
drive down costs, speed reimbursement and get more out of their
electronic medical records platform. proficienthealth.com
ClosedLoop.ai ClosedLoop’s
combines an intuitive machine learning platform with a comprehensive
library of healthcare-specific models and features. The clinical and
operational data-driven platform is designed for healthcare
organizations to leverage the power of AI in addressing their
biggest challenges. closedLoop.ai
Sitka Sitka
is rooted in value based care and is a full substitute for
fee-for-service driven specialty visits. trustsitka.com
Lumeris Lumeris
is empowering health systems to successfully deliver exceptional
value-based care through a comprehensive suite of capabilities
developed over a decade of building, testing, and proving the path
to value. A joint-operating partner in both value and risk, Lumeris
provides the complete continuum of value-based care competences via
the deployment of its Population Health Services Organization
(PHSO). The PHSO includes not only market-leading value-based
enablement capabilities, but also access to provider-centric,
tech-enabled Medicare Advantage and Direct Contracting plans. In
partnership with many of the nation’s leading health systems,
Lumeris has deployed its PHSO to more than 1 million patients and
7,000 physicians nationwide and successfully built 4.5+ star health
plans that consistently deliver better clinical and financial
outcomes for Medicare, Medicaid, Commercial, and Individual
populations. lumeris.com
Surescripts Formed
in 2001, Surescripts serves the nation through simpler, trusted
health intelligence sharing, in order to increase patient safety,
lower costs and improve the quality of care. We wok to deliver the
right information for the right purposes at the right time, all
while maintaining the highest standards for network access, security
and performance. The trusted insights we deliver empower healthcare
professionals, in turn transforming care for patients and everyone
who serves them. surescripts.com
Papa
Inc Papa
creates connections that matter. Across the country, health plans
and employers look to Papa to provide vital social support by
pairing older adults, vulnerable populations and families with Papa
Pals, trained and vetted companions, who provide a helping hand and
an open ear, resulting in less loneliness and better health. papa.com
Suture
Health SutureHealth’s
innovative ecosystem approach gives ACOs the tools to thrive under
value-based care. Developed by physicians, SutureHealth delivers
actionable and relevant clinical tools to the right people to drive
lower cost, higher quality care while seamlessly integrating into
provider workflows … without the overhead of backend integrations.
Manage preferred provider networks with ease while capturing
post-acute, signature-driven revenue using it’s flagship eSignature
service used by 10,000 provider organizations across 40+ states.
suturehealth.com
NEARLY
800 ATTEND NAACOS SPRING 2022 CONFERENCE Our Spring 2022 Conference was
held last week with 550 participating in-person and 220 joining virtually. Speaker
highlights included keynotes from CMS officials Dr. Meena Seshamani and Liz Fowler, and
National Quality Forum’s Dana Safran. The conference closed with a town hall Q&A
with CMS’s Meghan Elrington-Clayton, John Pilotte, and Aucha Prachanronarong. Both
virtual and in-person attendees have access to the conference recordings for six months.
We also ask that all attendees take a few moments to complete the conference evaluation. If any attendee needs continuing
education credits, please e-mail Emily Perron. Be
sure to mark your calendars for our Fall 2022 Conference, which is right around the
corner on September 7–9 at the Marriott Marquis Washington, D.C.
CMS
STRATEGY TO GROW ACOS OUTLINED IN NEJM Top officials at CMS listed
several updates to the Medicare Shared Savings Program (MSSP) that they’re thinking
about in order to grow ACO participation and savings. Those changes were outlined in a
recent New
England Journal of Medicine (NEJM) article. Importantly, they said they hoped to
use MSSP as “a chassis for growth and care transformation” by testing new ACO models and
features with that program. The CMS leaders vowed more waivers and better alignment of
features across ACO programs, although the piece was light on details on what exactly
that could entail. They also want to help smaller ACOs, those with less experience in
risk, and have less capital move to two-sided risk. Lastly, CMS wants to advance health
equity by expanding the reach of ACOs into underserved communities.
Also,
the article published data showing providers in ACOs outperform providers in the
Merit-Based Incentive Payment System (MIPS) on patient-experience and quality
performance measures. NAACOS is pleased to see this publication, which was mentioned
several times during the recent Spring Conference, and we hope to see many of these
changes in the upcoming Medicare Physician Fee Schedule.
LEGISLATIVE
CALENDAR COMPLICATED BY MIDTERM STRATEGIES For weeks, Congressional
Democrats have been at an impasse regarding the best strategy to retain control in the
Senate and even-more-likely-to-flip House. Prior to the leak of the U.S. Supreme Court’s
Roe v. Wade draft decision, two main strategic paths were available: (1) continue to
push forward on far-reaching legislation on tax reform, climate change, and drug
pricing, and aim for major additional successes to claim prior to the midterm elections;
or (2) focus on already accomplished items, such as infrastructure funding and
incremental flexibilities for telehealth. The first option would require a
reconciliation approach, which has been further complicated, and, in effect precluded,
by moderate Democrats’ concerns about rising inflation and adding additional currency
into the economy. The leak of the draft Roe v. Wade opinion, however, has changed the
calculus and created a third and arguably more viable option to energize the Democrat
base: a focus on the potential loss of abortion rights. We can expect many congressional
hearings and renewed interest on issues like the number of justices on the Supreme Court
and the filibuster. Abortion and privacy rights federal legislation will be revisited,
and advocates reenergized. While this could create some legislative vehicles, it is more
likely that this issue will dominate the ‘town square’ while little will be done on
other issues in Congress. For policy issues of direct impact for NAACOS, we are likely
to see a post-election package as the most viable path for advancement of our
legislative priorities. And other issues, such as telehealth flexibility, could stall if
the Supreme Court finalizes its draft decision.
NAACOS
ACTION FUND PRIOR APPROVAL FORMS AVAILABLE ONLINE NAACOS has been
working to ramp up activity with our Action Fund to support congressional candidates who
understand the interests of NAACOS members and value-based care providers. To comply
with federal election rules, NAACOS members must provide the NAACOS Action Fund with
prior approval before solicitations for funds can occur. Signing the approval does not
obligate you or your organization’s leadership to contribute. If you are your
organization’s primary contact with NAACOS, we encourage you to visit our website to
review our frequently asked questions and electronically sign the NAACOS Action Fund Prior Approval form.
CMS
RELEASES NATIONAL QUALITY STRATEGY CMS recently unveiled its National Quality Strategy, which includes a goal to move to more
digital quality measurement across CMS as well as advancing health equity, among other
goals. Additionally, CMS has released a digital quality measurement strategic roadmap. CMS has set a
goal of transitioning all quality measures used in its reporting programs to digital
Quality Measures (dQMs), though the agency no longer gives a specific timeframe for
doing so. CMS notes they expect the use of Fast Healthcare Interoperability Resources
(FHIR) application programming interface (API) technology will reduce the burden of
electronic health record (EHR) data mapping and reporting workflows to allow clinicians
to use timely data from multiple sources to support the delivery of high quality care
and to advance quality improvement.
MAY
19 WEBINAR ON ACO REACH, SPONSORED BY BAMBOO HEALTH So What Is
the ACO REACH Model? What Is Required? How Can Real-Time Data and Actionable
Interoperability Help? Starting January 1, 2023, CMS’ Global and
Professional Direct Contracting (GPDC) Model is getting a new name and look. CMS is
replacing GPDC with the redesigned ACO Realizing Equity, Access, and Community Health
(REACH) Model, intended to improve care coordination and outcomes for Medicare patients,
especially those in underserved areas. In this webinar, Bamboo Health (formerly Appriss
Health + PatientPing) will outline the incentives and requirements laid out by the new
ACO REACH Model and share how organizations can leverage actionable interoperability and
real-time data to make them achievable.
2022
NAACOS LEADERS IN QUALITY ANNOUNCED NAACOS recognized three ACO members
for their outstanding work to improve patient care in their communities at our spring
conference. St. Joseph’s Health ACO, UNC Health Alliance, and Summit Health are the
winners of the 2022 Leaders in Quality Excellence Award and were presented with awards
at the NAACOS Spring 2022 Conference. The award recognizes ACOs working to improve the
quality and safety of patient care and to advance population health goals. From the
field of ACOs submitting projects, the NAACOS Quality Committee selected the top three
to showcase the quality improvement efforts undertaken by NAACOS members and to
disseminate best practices. These ACOs exemplify the work being done across the country
to improve patient care by addressing skilled nursing readmissions, leveraging
preventive wellness visits, and reducing health disparities in their communities. More information on their work is available.
LAWMAKERS
DISCUSS MEDICARE TRUST FUND Last week, the House Energy and Commerce
and House Ways and Means Committees held hearings to discuss President Biden’s Fiscal
Year 2023 budget request. During the hearings several members asked Health and Human
Services (HHS) Secretary Xavier Becerra about the Biden administration’s plans for
addressing the solvency of the Medicare Trust Fund. Secretary Becerra told the
committees that the administration wants to use value-based care to lower costs and
improve health care quality. The Secretary highlighted that a long-term solution will
also need legislation from Congress. NAACOS is encouraged by the administration’s
support of value-based care and Congress’ interest in addressing Medicare solvency.
Earlier this year, NAACOS and seven other leading health groups submitted a statement to lawmakers on the Senate Finance
Committee asking Congress to support Alternative Payment Models (APMs) to help prolong
the solvency of the Medicare trust fund. NAACOS has also been working to build support
for the Value in
Health Care Act of 2021, legislation that supports ACOs and extends key
incentives to transition more providers into Advanced APMs. We encourage NAACOS members
to visit our Take Action
page to write your members of Congress, asking that they support these efforts.
CMS
ACCEPTING 2022 MIPS HARDSHIPS CMS is currently accepting 2022 hardship exception applications for MIPS. For ACOs subject
to MIPS, the APM entity can submit a MIPS Extreme and Uncontrollable Circumstances
Hardship Exception Application to request a reweighting for all performance categories.
This would give the ACO a neutral MIPS score (no positive or negative adjustment). To be
eligible for this exception, at least 75 percent of an APM Entity’s MIPS eligible
clinicians must qualify for reweighting of the Promoting Interoperability performance
category. There is no way to override or change this once the application is submitted.
As most ACOs will perform very well in MIPS, it is unlikely that a MIPS penalty would be
applied. Please note that this MIPS exception is separate from the Extreme and
Uncontrollable Circumstances Policies that are in place for the MSSP due to the COVID-19
Public Health Emergency (PHE).
CMS
CONTINUES WORK TO ADVANCE HEALTH EQUITY CMS has continued the momentum
of work across the agency to advance equity, recently publishing its 2022 Health Equity Fact Sheet, outlining agency-wide health
equity goals and key actions undertaken by CMS centers and offices to achieve these
goals. Last year, CMS Administrator Brooks-LaSure announced the CMS strategic vision and six strategic
pillars, the first of which is to advance health equity. Additional details on
how health equity will be advanced through the Center for Medicare (CM) were recently
published in a Journal of the American Medical Association (JAMA) Viewpoint
article outlining a two-fold approach for leveraging Medicare to advance health equity,
which includes improving operations and implementing policy interventions to promote
health equity.
CMS also recently issued the agency-wide 2022–2032 CMS Framework for Health Equity, which outlines five
key priorities to inform CMS’s efforts over the next ten years, which are to: expand the
collection, reporting and analysis of standardized data; assess causes of disparities
within CMS programs, and address inequities in policies and operations to close gaps;
build capacity of health care organizations and the workforce to reduce health and
health care disparities; advance language access, health literacy, and the provision of
culturally tailored services; and increase all forms of accessibility to health care
services and coverage. The framework details how these priorities will be addressed
across the agency and how shared goals will be advanced through collaboration with
federal and external partners. The 2022–2032 framework builds on the 2015 CMS Equity Plan for Improving Quality in Medicare, adding
new areas of focus to increase understanding of disparities and promote sustainable
actions to achieve health equity. Last week, CMS hosted a health equity symposium to
present on how CMS is operationalizing health equity across all programs; the recording and materials will be available in the coming weeks.
For more information on health equity as it relates to value-based care and ACO-specific
resources on health equity and social drivers of health, you can visit NAACOS’ Health Equity and ACOs
webpage.
HEALTH
EQUITY AND ACCOUNTABILITY ACT INTRODUCED IN HOUSE Last week, Rep. Robin
Kelly, Chair of the Congressional Black Caucus Health Braintrust, introduced the Health Equity and Accountability Act (HEAA) of 2022 (H.R. 7585). Since 2003, HEAA has been introduced by the
Congressional Tri-Caucus, comprised of the Congressional Asian Pacific American Caucus
(CAPAC), the Congressional Black Caucus (CBC), and the Congressional Hispanic Caucus
(CHC). The legislation directly addresses the intersection of health inequities with
race and ethnicity, as well as other factors such as language, immigration status, age,
disability, gender identity, socio-economic status, and others. The bill focuses on 10
topics: data collection and reporting; culturally and linguistically appropriate health
and health care; health workforce diversity; improving health care access and quality;
improving health outcomes for women, children, and families; mental health and substance
use disorders; addressing high impact minority diseases; health information technology;
accountability and evaluation; and addressing social determinants and improving
environmental justice. Importantly, the Social Determinants Accelerator Act (H.R. 2503/S. 3039), which NAACOS has endorsed, is included in the
legislative package. HEAA has been endorsed by more than 60 diverse stakeholder groups
and was introduced in the House with 58 original cosponsors.
INVESTIGATION
HITS MA PLANS HARD, WHILE LAWMAKERS CALL FOR PAYMENT CHANGES A
government watchdog found that Medicare Advantage (MA) plans sometimes delayed or denied
beneficiaries’ access to services, even though the requests met Medicare coverage rules.
The HHS
Inspector General report published last week found that roughly one in eight
prior authorization requests were wrongfully denied. The findings have already prompted
calls for CMS to revamp its prior authorization processes and oversight.
Additionally, on April 20, a group of Democratic lawmakers led by Sen. Elizabeth Warren
(D-MA) sent a letter to CMS highlighting concerns about overpayments to MA
plans. The letter urges CMS to mitigate announced payment increases and address
transparency in the MA program. Many of the lawmakers that signed the letter have also
expressed concerns with the Direct Contracting program.
CMS recently finalized a rule that makes several technical updates for
providers of both Medicare Advantage and Part D prescription drug benefit plans. Among
the changes proposed are greater standards for proving MA plans offer an adequate
network of providers and more transparency in medical-loss ratio reporting. There was
nothing noteworthy that directly relates to ACOs and value-based care entities in
traditional Medicare. The changes take effect next year. More information can be found
in the CMS fact sheet.
