NAACOS, AMA Urge Congress to Boost Value-Based Care, APM Incentives

February 04, 2022 - A group of eight healthcare organizations, including the American Medical Association (AMA) and National Association of ACOs (NAACOS), have asked Congress to increase their efforts in promoting value-based care and alternative payment model (APM) adoption.

In a letter sent to the Senate Committee on Finance Subcommittee on Fiscal Responsibility and Economic Growth, the organizations highlighted the importance of APM participation but stated that providers need greater incentives from Congress to join.

AMGA, America’s Physician Groups, Association of American Medical Colleges, Health Care Transformation Task Force, Medical Group Management Association, and Premier healthcare alliance were also among the letter’s authors.

According to the most recent Medicare Trustees’ Report to Congress, the Medicare Trust Fund solvency will be depleted by 2026. By encouraging more providers to enter APMs, legislators could help avoid this fate.

The organizations urged the Committee to consider the Value in Health Care Act, which could help increase APM incentives. The bill would restore shared savings rates for accountable care organizations (ACOs) to the levels they were at when the Medicare Shared Savings Program (MSSP) first launched.

Additionally, the bill would modify risk adjustment to better reflect the factors participants encounter, put a stop to the labeling of ACOs as low or high revenue, and eliminate ACO beneficiaries from the regional benchmark to ensure ACOS are not penalized for achieving savings.

The Value in Health Care Act would also extend certain Medicare Access and Chip Reauthorization Act (MACRA) policies, including the 5 percent incentive payment for Advanced APM participants. This bonus is set to expire at the end of 2022, but the bill would extend it for another six years. In addition, the HHS secretary would gain more freedom to determine the thresholds that providers must reach to receive the incentive.

The federal government created the MSSP, Center for Medicare and Medicaid Innovation, and MACRA in order to boost APM adoption and lower healthcare costs for patients through value-based care delivery. However, there are still more than 30 million traditional Medicare beneficiaries who receive unmanaged, uncoordinated care, the organizations stressed.

The letter noted that recent CMS data shows a modest year-over-year growth in ACO participation, adding to the trend of flat MSSP participation.

“Greater incentives are needed for providers to participate in APMs, to outweigh the risk, uncertainty, and sizeable upfront and ongoing investments needed to participate,” the organizations wrote. “Congress can play a strong role in rebalancing those incentives and encouraging growth in Medicare programs that promote better patient outcomes at lower cost.”

APMs, value-based care, and ACOs have proven their ability to lower Medicare spending.

ACOs have saved Medicare $13.3 billion in gross savings and $4.7 billion in net savings since 2021, according to data from NAACOS. Additionally, experts have found that ACOs lower annual Medicare spending by 1 to 2 percent, amounting to nearly $200 billion in savings over ten years.

The organizations also highlighted in their letter how APMs improve quality of care for patients. Patients are likely to receive high quality care, as providers in APMs must meet certain quality measures to receive payment incentives.

A past report from the HHS Inspector General found that ACOs improved their performance on 82 percent of the quality measures after three years of MSSP participation. Meanwhile, 98 percent of ACOs met or exceeded quality standards.

In addition to incentives for providers, APMs may offer a handful of benefits to patients. ACO models do not have networks or prior authorization, allowing Medicare beneficiaries to choose any participating provider in the ACO.

“APMs focus on value over volume with a commitment to driving wellness and whole-person care,” the letter stated. “Providers in APMs place a premium on identifying high-need patients, with an emphasis on delivering proactive, preventive care, chronic disease management, care management, and better transitions of care along with a myriad of other tactics that yield better patient outcomes.”