ACO Coalition Meeting Explores What’s Next for Medicare, Payment Reform, and the ACA

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Despite progress, tying healthcare payments to value has proved easier in theory than in practice, according to speakers at this fall’s meeting of the ACO & Emerging Healthcare Delivery Coalition. Experts, convened October 20-21, 2016 by The American Journal of Managed Care, looked ahead at the challenges the next president will face with the future of the Affordable Care Act.

The ACO & Emerging Healthcare Delivery Coalition is an initiative of The American Journal of Managed Care.

The challenge facing CMMI and CMS more broadly is how to manage these millions of different models. There's just too much.

While problems with the healthcare Marketplace may be one of the next president’s first controversies, the ongoing work to connect payment with performance will continue with bipartisan support, according to experts who appeared at the fall meeting of the ACO & Emerging Healthcare Delivery Coalition, which convened October 20-21, 2016, at the Westin. Anthony D. Slonim, MD, DrPH, president and CEO of Renown Health in Nevada, served as meeting chair.

For all the bickering over the Affordable Care Act (ACA), keynote speaker Mark McClellan, director of the Duke-Margolis Center for Health Policy, said there are areas that enjoy bipartisan support: both sides see the need for innovation, for greater collaboration to collect data, and for regulatory reforms to allow smaller players to compete.

After years of pressing providers to squeeze waste from the system, McClellan and other speakers said there’s a recognition that it’s time to get consumers engaged. AJMC’s co-editor-in-chief A. Mark Fendrick, MD, director of the University of Michigan’s Center for Value-Based Insurance Design, put it this way: So far, most of the work in ACOs is in “supply side” initiatives aimed at providers. It’s time, he said, “to understand the demand side.”

As accountable care organizations, hospitals, and physicians are learning, the Center for Medicare and Medicaid Services’ (CMS) relentless push for new payment bundles and methods of sharing risk, alongside requirements for electronic health records, has many scrambling to keep up.

AJMC co-editor-in-chief Michael E. Chernew, PhD, director of the Healthcare Markets and Regulation Lab at Harvard University, said, “The challenge facing (the Center for Medicare and Medicaid Innovation) and CMS more broadly is how to manage these millions of different models. There’s just too much.”

“I wish this journey was easier than it is,” said McClellan, who served as FDA commissioner and administrator of CMS under President George W. Bush.

Among meeting highlights:

  • The final rule for the Medicare Access and CHIP Reauthorization Act (MACRA), released last week, features key adjustments from the original proposal; 2017 will be a transition year in which quality will carry more weight in scores, which should help those physicians trying to adapt to value-based payment.
  • A presentation and panel discussion by the Camden Coalition of Healthcare Providers, which operates across the Delaware River in New Jersey, shared how the technique of “hotspotting,” which uses data to stratify patients by complexity rather than condition. This allows greater focus on those patients who are frequently in the emergency department and would continue to consume services without more help. Providers have financial incentives to offer more intense follow-up for these patients.
  • Moderator Cliff Goodman, PhD, led the latest installment of Healthcare 2020 with Chernew, Fendrick, and Eleanor M. Perfetto, PhD, MS, senior vice president of Strategic Initiatives at the National Health Council. The three discussed the prospects for the next president and Congress to address problems on the exchanges in 2017, as well as the need to address the fallout of high deductible plans on consumer healthcare decisions.

About the Journals and AJMC.com

The American Journal of Managed Care is the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms. Other titles in the franchise include The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

About the ACO Coalition

As ACOs and other emerging delivery and payment models evolve and move away from traditional fee-for-service system models toward cost-effective and value-based care, the need to understand how these models will evolve is critical to building long-term strategic solutions. The mission of the ACO Coalition is to bring together a diverse group of key stakeholders, including ACO providers and leaders, payers, IDNs, retail and specialty pharmacy, academia, national quality organizations, patient advocacy, employers and pharmaceutical manufacturers to work collaboratively to build value and improve the quality and overall outcomes of patient care. Coalition members share ideas and best practices through live meetings, Web-based interactive sessions and conference calls. Distinguishing features are the Coalition’s access to leading experts and its small workshops that allow creative problem-solving. To learn more, click here.

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