MedPAC Recommends Reduced Number of APMs, No CHART ACO Yet

The Medicare Payment Advisory Commission (MedPAC) agreed that the Department of Health and Human Services (HHS) must put together a consolidated group of alternative payment models in order to improve demonstrations.

From the commission’s recommendation:

The Secretary should implement a more harmonized portfolio of fewer spending alternative payment models that are designed to work together to support the strategic objectives of reducing spending and improving quality.

According to Inside Health Policy, MedPAC will continue to look at alternative payment models for its next cycle and will dig deeper to make more analytic recommendations. Questions were raised about accountable care organizations and bundles, and whether or not one kind of demonstration would work better than the other.

Managed Healthcare Executive is asking similar questions this week, in an interview with senior vice president of Episodes of Care, François de Brantes, on whether or not the Direct Contracting payment model is just fee-for-service with more steps. Here’s what he had to say:

[Direct Contracting] is actually a relatively big departure from all of the other models that the Center for Medicare and Medicaid Innovation — CMMI — … they all still rely on underlying fee-for-service payments. This is the first time when CMS has said, “yes, we’re still going to require provider organizations to submit claims, because asking them to stop a known process for a segment of their patients doesn’t make sense.”

The COVID-19 pandemic also put the transition to value-based care models into overdrive, as a model that prioritized patient health quality outcomes over volume. Managed Healthcare Executive looked into how the expedited transition is going, analyzing interoperability, systemic change and the need to protect vulnerable patients.

While these are three steps to bring value-based care to the forefront of healthcare, a common theme woven throughout is the need to work together. To share patient data amongst organizations, we must all work to comply with CMS mandates. Systemic change will only happen if every stakeholder in the healthcare system opts “in” to transformation for the benefit of patients.

The Centers for Medicare and Medicaid Services (CMS) has delayed the accountable care organization (ACO) track of the Community Health Access and Rural Transformation (CHART) Model, and gave no reason for delay. The CHART model addresses rural healthcare delivery disparities, according to Healthcare Finance News. It seeks to test whether investments via capitated payments, in addition to operational flexibilities would improve access to rural care while reducing costs.

The National Association of ACOs (NAACOS) was disappointed in this decision. From NAACOS president and CEO Clif Gaus:

We look forward to working with the CMS Innovation Center to expand the eligibility and scale of a new ACO loan program for rural and small ACOs. CHART’s precursor, the ACO Investment Model, was one of the most successful Innovation Center models, creating a path toward alternative payment model participation for providers who would otherwise struggle to get there.