Value in Health Care Act introduced in House would bolster ACOs
The bill would provide substantive reforms to support and encourage greater participation by health care providers in ACOS, particularly in rural communities.
Value-based health care continues to gain momentum, on Capitol Hill as well as within the industry.
“The transition to value has been an ongoing effort for the past decade,” said Allison Brennan, senior vice president of government affairs for the National Association of Accountable Care Organizations (ACOs). “We have a shift in value that is born out of the fact that our health care system needs to move away from focusing on volume of service to focus on whole-person care, as well as value of care. The shift to value has received strong bipartisan support. We really have seen support from legislators and policymakers on both sides of the aisle.”
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An ACO is group of doctors, hospitals and other health care providers who provide batter care at a lower cost, she said. When ACOs improve the quality of patient care while lowering the cost, they keep a portion of savings.
Brennan moderated a July 21 webinar about value-based care. She pointed out that ACOs focus on population health, quality improvement and bending the cost curve — meaningful transformations that take time, hard work and resources.
“Medicare has played an important role in the overall shift to value,” she said. “In the past decade, the Centers for Medicare and Medicaid Services has implemented more than 50 alternative payment models. Prominent among those is the Medicare Shared Savings Program, one of a number of ACO models that have come out of CMS. It is the largest of the accountable care models, and one that represents nearly 11 million beneficiaries and nearly 500,000 participating clinicians.”
Since 2012, ACOs have given Medicare $8.5 billion in gross savings and $2.5 billion in net savings.
“In 2017 and 2018, a test report found that 98% of ACOs met or exceeded quality measures after participating for three years and outperformed regular fee-for-service providers in 81% of quality measures,” said Rep. Suzan DelBene, D-Wash. “The pressure is on for Congress to advance policies that prioritize value in our health care system and make it easier for providers to deliver care to their patients.”
On July 20, DelBene joined House colleagues Peter Welch, D-Vt.; Darrin LaHood, R-Ill.; and Brad Wenstrup, R-Ohio, to introduce the Value in Health Care Act. The bill, called the Value Act for short, strengthens the Medicare Shared Savings Program by updating the program to recognize and reward ACOs. Specifically, the bill:
- Increases shared savings rates,
- Updates risk adjustment rules,
- Eliminates the artificial distinction between high- and low-revenue ACOs,
- Addresses ACOs’ “rural glitch” and
- Restarts the ACO Investment Model.
The bill also reinforces the shift to value-based care by extending the 5% advanced alternative payment model incentive payments for an additional six years and authorizing a study of the overlap of various Medicare APMs. Finally, the bill mandates a report by the Government Accountability Office on health outcomes and racial disparities in Medicare patients cared for by ACO participants compared to traditional Medicare and not assigned to any other APM.
Fourteen national health care stakeholder organizations wrote a letter in support of the legislation, saying “The Value in Health Care Act of 2021 makes a number of important reforms to strengthen Medicare’s value-based care models and accountable care organizations to ensure that these models continue to produce high-quality care for the Medicare program and its beneficiaries as well as to generate savings for taxpayers.”
LaHood said the bill would provide substantive reforms to support and encourage greater participation by health care providers in ACOS, particularly in rural communities. “As Congress continues to discuss ways to lower costs and promote greatest access to quality health care, support for the work done by ACOs and the transition to value-based payment systems must remain a part of the conversation,” he said.
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