The AAFP advocates to the five largest health plans for family physicians. The AAFP private payer advocacy agenda includes but is not limited to:
It is the policy of the AAFP that health plans should provide a mechanism for physicians in value-based contracts to submit supplemental data for all lines of business. The Academy tracks what payers accept supplemental data for the top five payers with whom the AAFP has relationships.
The AAFP developed model guidance which states, “In addition to receiving HEDIS data via claims and encounters, [payer] should also accept submission of supplemental data to satisfy HEDIS measures and close gaps in care in value-based contracts.” The consequences of a health plan’s inability to accept and record data may result in physicians not receiving payment otherwise earned under a value-based contract.
|HEALTH PLAN||COMMERCIAL||MEDICARE ADVANTAGE||COMMENTS|
||No||No||Cigna Collaborative partners can use the iCollaborative software to manually attest to gap closure, thus improving their quality scores and gap closure rates.|
|Aetna||No||Yes||Aetna is considering accepting supplemental data for their commercial business as their systems evolve.|
|Anthem||No||Yes||Anthem is working to have a process in place to accept supplemental data for commercial business in 2019.|
In response to BCBSRI’s modifier 25 policy, the AAFP sent a letter asking them to re-evaluate their modifier 25 reporting and payment policy.
The letter voices concern that BCBSRI’s modifier 25 policy significantly hampers family physician’s ability to financially operate a medical practice and transition to value-based care. It also is detrimental to patient access to care.