January 20, 2022, 1:23 p.m. — The Academy’s advocacy for value-based health care models continues this month with Health Care Value Week, a series of events focused on advancing value-based care that runs Jan. 24-28. Especially during another long pandemic winter, this is a welcome and unique opportunity to zoom out and examine long-term strategies — and solutions — for increasing investment in primary care and giving primary care practices ample support and flexibility.
Broadening value-based primary care — which we know will improve quality of care, reduce costs and eliminate a range of health disparities — is a crucial transformation that will help the nation address its most intractable health care challenges across public and private programs. To do it, we need to achieve multipayer alignment across models and more robust participation opportunities for those who care for Medicaid enrollees, including practices at all levels of experience.
That’s why the AAFP, together with a diverse group of leading health industry stakeholders, is convening Health Care Value Week. Our strong coalition is celebrating a record of steady progress while charting a path forward on key legislative and regulatory priorities. Each day of the free program, AAFP members will be able to participate in virtual summits featuring thought leaders and government officials, as well as tune in to conversations with federal lawmakers.
The Academy and its Value Week partners believe value-based care is the most fiscally sustainable approach to health care transformation. Many of the models tested so far have delivered cost savings for the Medicare program and commercial payers while allowing clinicians to offer more robust and coordinated care for their patients. We’re also bullish on value-based care as an avenue by which to reduce health disparities such as those so dramatically revealed by the pandemic. Specifically, greater flexibility in payment models can equal greater opportunity to address social determinants of health.
I’m participating in two of the week’s keynotes, starting with a roundtable at 1:30 p.m. ET Jan. 24. As I write this, I’m also preparing to interview Dan Tsai, CMS’ deputy administrator and director of the Center for Medicaid and Children’s Health Insurance Program Services, for a conversation on Medicaid reform at 10:45 a.m. ET Jan. 26. Tsai was at the helm of Massachusetts’ combined Medicaid-CHIP program, MassHealth, when that system underwent a major transformation toward value-based payment while unrolling a suite of initiatives aimed at addressing social determinants of health. I’m eager to ask that him what lessons from that experience he’ll bring to his new federal job.
More recently, Tsai and CMS Administrator Chiquita Brooks-LaSure were among the authors of a 2021 Centers for Medicare and Medicaid Innovation report outlining a 10-year plan for value-based care. They also last year issued a set of strategic priorities for Medicaid and CHIP centered on coverage, access, equity, innovation and whole-person care. That gives us a lot to talk about, and I’ll be asking him for examples of how his agency will use value-based models to promote these priorities. You should also expect us to talk about innovation happening at the state level under Medicaid 1115 Waiver demonstrations and managed care plans.
For the larger panel, I’ll be joined by Iona Health’s Rushika Fernandopulle, M.D., M.P.P.; Aledade’s Farzad Mostashari, M.D.; and Agilon Health’s Steve Sell, M.B.A. Together, we’ll lay out why we must transition to value-based care, what role purchasers will play in that process and how finally escaping fee-for-service care can help address workforce and burnout challenges.
The week’s discussions will also include insights into our legislative advocacy strategy. Not that the numbers fail to sell themselves. Even as health care costs amounted to an eye-popping 17.7% of U.S. GDP in 2019 and the projected insolvency of the Medicare Trust Fund gallops nearer, Medicare Shared Savings Program accountable care organizations generated $1.9 billion in net Medicare savings in 2020 (with an average quality score of 98%). And some in Congress as well as within the Biden administration have named value-based care as one of the tools that can be wielded against harmfully disproportionate health care spending. Still, COVID-19 has limited options and stymied participation in value-based models, so it’s an important moment to redouble our efforts.
Among the targets in our sights is the MACRA bonus. The established 5% bonus has been vital to clinicians needing help to cover the investment costs of moving to new payment models while offsetting losses associated with transitioning away from fee-for-service. But these bonuses are set to expire in the 2024 payment year, which will be based on 2022 performance. That’s far from ideal for physicians. Nor would it help CMS, which wants to move every Medicare and most Medicaid beneficiaries into accountable care relationships by 2030. That’s why we’re urging Congress to clear the path. Academy members at the vanguard of positive change need every available resource to keep leading the way. We’re working to make certain that policymakers understand this and think beyond 2023.
CMMI gets it. The 10-year plan I just mentioned isn’t subtle about putting value-based care at the fore: The vision it lays out includes driving accountable care, advancing health equity, supporting care innovations, improving access by addressing affordability, and working with partners such as the Academy toward revising today’s models and developing future ones.
That obviously all sounds promising. Delivering on that promise, though, requires commitment and engagement from stakeholders, which is where Value Week as well as the Academy’s advocacy come in. If you’re among the AAFP members already staking out the value-based frontier, I urge you to register (again, it’s free, and the schedule is divided into bite-sized pieces) and share your own innovative approaches, challenges and experiences.
To no one’s surprise but to everyone’s relief, HHS last week extended the public health emergency declaration for another 90 days. The COVID-19 flexibilities allowed via the PHE remain vital in the fight against the pandemic, and this most recent renewal couldn’t be timelier given the omicron surge.
Equally important — and answering recent Academy advocacy — the White House and the CDC last week took much-needed steps to improve access to testing in schools and distribute tests (via the new website covidtests.gov and the U.S. Postal Service) and N95 masks to Americans.
These welcome developments follow our urgent call this month, alongside fellow physician groups, for the administration to fortify its efforts to beat COVID-19.
“It is past time for federal, state and local leaders to hear our organizations’ and our members’ calls for bold action to truly support frontline clinicians by prioritizing their mental health and overall wellbeing, as well as committing to a long-term multilayered public health response to contain COVID-19 and bolster our overwhelmed health care system,” said our Jan. 7 letter to the president. (Our co-signatories were the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Psychiatric Association and the American Osteopathic Association.)
Establishing a channel through which Americans can receive reliable tests and CDC-recommended masks marks an excellent, if overdue, renewal of federal support for citizens. But experts suggest that we’re not yet past Omicron’s peak, and the country’s health care system is overtaxed as never before. So the Academy will continue its pressure on leaders to dig deeper and firm up their support for those of you at the front line.
Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.
Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy. Read author bio »