Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Industry Orgs Urge Lawmakers to Continue Value-Based Care Push

Lawmakers should not abandon the value-based care transition, but work to accelerate alternative payment model improvement and development, the groups stated.

Over 120 healthcare leaders called on lawmakers to maintain the value-based care transition

Source: Thinkstock

- Over 120 healthcare industry groups, including hospitals, healthcare systems, payers, and professional organizations, recently urged the Trump administration and Congress to not discontinue or slow the transition to value-based care.

In the letter to President Trump and Vice President Pence, the long list of healthcare organizations, including industry heavy-hitters such as the American Hospital Association (AHA), Premier Inc., the American Medical Association (AMA), and Aetna, agreed to help lawmakers to accelerate value-based care implementation.

“Through private and public sector alignment, the move toward value-based care is succeeding, measurably improving healthcare quality and contributing to historically low costs,” wrote the organizations. “Now is not the time for policymakers to signal a shift away from value-based care, either through action or inaction.”

Similarly, the American Medical Group Association (AMGA) penned a letter to House Speaker Paul Ryan (R-WI) on Wednesday calling for the value-based care transition to remain a Congressional priority, especially since the Quality Payment Program launched earlier this year.

While the AMGA urged lawmakers to prioritize meeting provider data needs, making more capital available for the transition, and improving MACRA implementation, the over 120 healthcare industry groups gave the Trump administration core principles for continuing the value-based care transition.

READ MORE: What Is Value-Based Care, What It Means for Providers?

First, the organizations advised lawmakers to help the healthcare industry boost patient engagement efforts. For value-based care models to succeed, patients should play more of an active role in making healthcare decisions. But they will need more information access and support from providers.

The patient voice should also be heard when payers and other stakeholders develop quality measurements, the groups added.

“Invest in engaging patients in the development of measures of provider performance that are relevant to them and consistently and transparently reported by all public and private payers,” the letter stated.

Next, the Trump administration and Congress should boost provider access to “timely, accurate and complete claims data to better facilitate care management,” the organizations wrote.

Easier and more claims data access allows providers to better understand their patient populations, identify care gaps, and reduce costs. For example, the CMS-run Comprehensive Primary Care model developed integrated claims data reports for participating primary care practices. Practices gained access to data from multiple payers in a single report.

READ MORE: Preparing the Healthcare Revenue Cycle for Value-Based Care

Participating practices stated that the claims data access allowed their providers to track cost patterns for high-risk patients and develop the most appropriate interventions to improve outcomes while reducing costs.

Earlier this month, former CMS and Office of the National Coordinator (ONC) leaders also described data as the “lifeblood of the value-based payment environment.” Therefore, they advised the new administration to better meet provider data needs.

Before the leaders left their posts on Jan. 20, they suggested improving health IT interactions through standard application program interface use, increasing the health IT market, boosting affordable shared services use, and ensuring healthcare data transparency. They also advised the new administration to standardize quality measures and align measurements and reporting requirements across payers.

After claims data access improvements, the healthcare coalition called for more alternative payment model improvements. The groups asked lawmakers to “design voluntary payment models that incent greater participation and achieve the highest quality and cost value based on patient choice and competitive markets.”

President Trump’s pick for Department of Health and Human Services (HHS) Secretary, House Representative Tom Price (R-GA), told CMS in October 2016 that the federal agency overstepped its authority by mandating Medicare provider participation in some alternative payment models.

READ MORE: Understanding the Value-Based Reimbursement Model Landscape

But the coalition’s recent letter to the Trump administration highlighted how voluntary alternative payment models should contain adequate incentive payments to spur value-based care changes. The organizations specifically suggested appropriate “incent access to medical innovations and treatments that hold the potential to improve quality of care and reduce overall system cost.”

The industry groups also urged lawmakers to improve alternative payment models by expanding fee-for-service waiver use and incorporating patient socioeconomic status into value-based payment adjustments.

Some fee-for-service regulations, such as the 25 Percent Rule for long-term care hospitals, can impede value-based care because value-based behaviors, such as provider collaboration and shared accountability, violate anti-kickback and other healthcare fraud prevention laws.

Lawmakers should, therefore, reduce regulatory barriers that prevent providers from fully participating in value-based care models.

Patient socioeconomic status should also be considered when public and private payers determine value-based incentives or penalties, the groups added.

The HHS Office of the Assistant Secretary for Planning and Evaluation similarly recommended social risk determinants to be added to payment methodologies in Medicare value-based reimbursement programs. The office found that some social risk factors result in worse patient outcomes, causing hospitals that treat a disproportionate percentage of patients with social risk factors to face more value-based penalties.

While the groups offered alternative payment model improvements, the letter still advocated for more development of value-based reimbursement models.

The groups recommended that the healthcare industry “promote public and private investment in the transparent, evidence-based testing and scaling of new alternative payment models as directed in MACRA so that clinicians, other healthcare providers and payers can learn how payment models work and evolve in the clinical setting.”

Additionally, the group of over 120 healthcare organizations advised lawmakers to better align value-based care models across payers, providers, and other stakeholders. The healthcare industry should start by building on existing models and developing incentives that align various stakeholders.

Then, lawmakers and healthcare industry leaders should work to align value-based care models across public and private payers to create a “sustainable value-based payment marketplace.”

Many providers in value-based care models face significant misalignment across programs, especially in terms of quality measures and reporting. A 2013 Health Affairs study showed that only 5 percent of quality measures used by commercial health plans were included in more than half the plans and only 17 out of 301 Physician Quality Reporting System measures were the same as commonly used measures among commercial health plans.

The Government Accountability Office (GAO) stated in October 2016 that quality measure misalignment was a significant burden for providers and diminished their ability to develop high-impact quality improvement initiatives.

Since the value-based care transition started nearly 20 years ago, the road has not always been smooth. But the healthcare organizations co-signing the letter intend to work together and with lawmakers to continue the transition.

“We stand prepared to work vigorously with the Administration and the Congress to expand upon the quality and cost savings progress made in America, and we look forward to taking the next steps to reach and surpass the tipping point where value-based healthcare becomes a sustainable marketplace for generations of Americans to come,” concluded the letter.

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