COVID-19
PHE SET TO BE EXTENDED AGAIN IN JULY NAACOS anticipates the COVID-19
Public Health Emergency (PHE) to be renewed again in July, which would extend it through
mid-October. The Biden administration promised a 60-day notice of the PHE’s expiration,
but that soft deadline came and went this week with no word on the PHE’s future from
administration officials. As such, we anticipate the PHE will receive another 90-day
extension when it comes up for renewal on 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 performance year expenditures, and broad application of
telehealth waivers. More
information on COVID-19 is available.
Welcome
New Business Partners
ClosedLoop.ai ClosedLoop
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
Papa
Inc 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
Indivior Patient
needs inspire us. Indivior is working to change patients’ lives by
developing medicines to treat substance use disorders and serious
mental illnesses. indivior.com
Sitka Sitka
is a national, fully-remote multi-specialty provider network
deployed through our proprietary virtual consultation platform to
at-risk primary care providers. trustsitka.com
Intellihealth Intellihealth
is a technology company focused on delivering software solutions and
managed services to medical care providers, employers, insurers, and
consumers in the field of metabolic medicine. intellihealth.co
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. suturehealth.com
NAACOS
PUBLISHES ACO REACH FAQS; DC LEARNING DISCUSSION TOMORROW NAACOS has
put together a set of Frequently Asked Questions (FAQs) to help members better
understand the new ACO REACH Model. Topics covered include health equity, benchmarking,
capitated payments, and others. Find it and other REACH-related resources on NAACOS’s ACO REACH page.
Additional questions can be sent to ACOREACH@NAACOS.com.
NAACOS is
holding its next Direct Contracting Learning Discussion this Friday. As a reminder,
these monthly events are meant for DCEs to share feedback, questions, concerns and
points of interest. We are limiting participation to those participating in the model in
2022. As such, advanced registration is required. If you have questions or
topics of conversation you want discussed, please share them in advance by emailing directcontracting@naacos.com. The
point is to make these collaborative discussions and a forum for shared learning. We ask
that you come prepared to share your questions, perspectives, and react to issues at
hand.
BOOT
CAMP DISCOUNTED ROOM RATE ENDS FRIDAY! REGISTER NOW! Everything 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. The discounted room rate has been extended
through Friday, May 20. Make your reservations as soon as possible. Reservations made
after this date are based on availability and subject to regular pricing. This boot camp
will provide an opportunity to learn from ACO’s 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. See
the detailed
agenda. NAACOS boot camps are designed for the ACO leadership team. Business
partners are not eligible to attend. There is no virtual option and in-person registration is
open, but space is limited to 100 people!
CMS
TO PAY ADVANCED APM BONUS THIS SUMMER CMS staff announced during a
recent webinar that eligible clinicians who were Qualifying Advanced APM Participants
(QPs) based on their 2020 performance will begin receiving incentive payments this
summer. CMS also published a comprehensive list of APMs for 2022. The agency will begin
publishing QP determinations for 2022 performance on the QPP Participation Status Tool
in July after the first snapshot. As a reminder, PY 2022 is the final year for providers
to qualify for a 5 percent incentive payment. NAACOS and our stakeholder partners are
engaging with Congress asking lawmakers to extend these incentives for six additional
years. Contact your member of Congress today to ask them to support an
extension of these critical incentive payments for value-based care providers.
SENATORS
INTRODUCE MEDICARE FOR ALL LEGISLATION On May 12, Senator Bernie
Sanders (I-VT) introduced a Senate version of “Medicare for All” legislation. The bill
establishes a federally administered national health insurance program that would be
implemented over a four-year period. The new system would make global lump sum payments
to hospitals, skilled nursing facilities, and dialysis facilities for operating expenses
and patient care. While the Senate bill is similar to a version that’s been introduced
in the House, it does not sunset the Medicare Shared Savings Program or other APMs.
Additionally, the Senate bill establishes a fee-for-service system for individual
providers and group practices and allows the Secretary of Health and Human Services
(HHS) to apply payment reform activities such as demonstrations, waivers, or any other
provider payment agreements that are included in the Medicare program. While the Senate
Budget Committee held a hearing on the bill last week, it’s not expected to advance
through the legislative process this Congress.
CONGRESS
ADDRESSES EMERGENT ISSUES Amid a mid-term election push and nation-wide
congressional primaries this week, both parties are looking for policy wins while
wrestling with emergent domestic and foreign policy issues. On the domestic front, the
U.S. Food and Drug Administration and Biden White House are under fire for the
nation-wide shortage of baby formula. Members from both sides of the aisle have sprung
into action to ask for investigations, increased oversight, and additional production.
Republicans have coupled the issue with kitchen table concerns about the rising cost of
goods, including gas, and inflation. Democrats have pointed toward supply chain issues
and are focused on potential advancement of the American COMPETES Act as an avenue to
address underlying economic issues. Also at the top of the Majority party’s agenda is
the advancement of the Domestic Terrorism Prevention Act in the wake of the mass
shooting in Buffalo, N.Y., over the weekend. COVID-19 funding hangs in the balance, with
little to no activity on the measure this week. With respect to foreign policy issues,
additional Ukraine aid appears to be advancing in Congress, with some bipartisan
support. The topline issues are dominating the congressional calendar for the duration,
with healthcare related items such as the medical device user fees and appropriations
making their way through committee consideration. Advocates expect that Congress my act
on certain healthcare and tax extenders as part of a year-end package, and that is
NAACOS’ target for an Advanced APM bonus and QP threshold fix.
Welcome
New ACO Members
UCMCNACO Chicago,
IL
Circulo
Health ACO Columbus,
OH
HOUSE
MOVES TOWARD VOTE ON MA PRIOR AUTHORIZATION Under updated House rules,
the Improving Seniors’ Timely Access to Care Act (H.R. 3173) now has enough cosponsors
to skip the committee process and go directly to a vote by the full House of
Representatives. The bill establishes several requirements and standards relating to
prior authorization processes under Medicare Advantage (MA). Support for prior
authorization reform has been growing after the HHS Office of the Inspector General
released a report showing roughly one in eight prior authorization requests
were wrongfully denied.
REMINDER:
REVIEW AND SIGN PAC PRIOR APPROVAL FORMS 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 prior approval form.
CMS
PUBLISHES RESOURCES ON COMMUNICATING WITH PATIENTS NAACOS is pleased
to see more tools from CMS to better explain the work of ACOs to patients, and we are
sharing these with our ACO members to help you in your work. CMS has created short, two-minute videos on ACOs and the Center for Medicare and
Medicaid Innovation Center. These are paired with webpages that explain in writing what
ACOs are and the goals of the Innovation Center. Feel free to share these in your
networks. As a reminder, NAACOS has a number of its own resources to explain ACOs to a
variety of audiences on its About ACOs page.
LAN
ANNOUNCES NEW ACCOUNTABLE CARE DEFINITION Last week, the Health Care Payment Learning &
Action Network (LAN) hosted the event “Building Bridges to
Person-Centered Care,” with opening remarks from CMS Administrator Chiquita
Brooks-LaSure and Innovation Center Director Liz Fowler, in which they shared how CMS
plans to align with LAN initiatives to help achieve the agency’s goal of having all
traditional Medicare beneficiaries in an accountable care relationship by 2030.
Additionally, LAN leadership unveiled a new definition of accountable care, which states
that “accountable care” aligns care teams to help realize the best
achievable health outcomes for all through comprehensive, high-value,
affordable, longitudinal, person-centered care. This new
definition is intended to resonate with a general audience in order to facilitate
broader efforts to spread awareness and education about value in health care. Later this
summer, the LAN will be launching an “Accountable Care Action Collaborative” in order to
convene a diverse group of experts to lead their work to drive accountable care. The LAN
is a multi-stakeholder group with both public and private health care leaders, and CMS
has stated the intention to collaborate more with groups such as the LAN in order to
advance shared goals around health care payment reform.
PTAC
TO DISCUSS POPULATION-BASED TCOC MODELS AT UPCOMING MEETING The
Physician-Focused Payment Model Technical Advisory Committee (PTAC) will host the second
in a series of public meetings focused on the role that
population-based total cost of care (TCOC) models can play in optimizing health care
delivery and value-based transformation in the context of APMs and physician-focused
payment models. A meeting, on June 7–8, will discuss lessons learned from
entities that have been successful in bearing financial risk, best practices for
incorporating specialty care innovation into population-based TCOC models, relevant
performance metrics, and how to address health equity in TCOC models. Last month, NAACOS submitted comments in response to PTAC’s request for
input (RFI) on key issues and options related to the development and implementation of
population-based TCOC models, which included recommendations related to payment
structures and financial incentives, care delivery strategies, quality measurement,
health equity, and other considerations.
NEW
STUDY PROFILES HOME-BASED CARE PROGRAMS IN ACOS ACOs are increasing
their investments in home-based care programs according to new research published last
week in the American Journal of Managed Care. The study was based on survey data from
151 ACOs. Twenty-five percent of the ACOs had formal home-based care programs, 25
percent offered occasional home visits, and 17 percent were actively developing new
programs. ACOs offered a diverse array of home-based services including primary care,
acute medical care, palliative care, care transitions, and interventions to address
social determinants of health. Most ACOs with home-based programs expressed interest in
expanding services but were concerned about their ability to demonstrate a return on
investment (ROI). Many services provided are not billable, and therefore ACOs are
hesitant to fund expansions without strong evidence of ROI. The study recommended that
CMS expand post-discharge home-visit waivers to all risk-bearing ACOs and permanently
cover telehealth for patients receiving home-based primary care to improve the financial
viability of these programs.
