Letter from Washington: The Path Forward for Value-based Care

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Dec 05, 2016

In Washington, D.C., the path from change to speculation to adaptability moves pretty quickly, evidenced in part by the lame-duck Congress moving the long-awaited and bipartisan 21stCentury Cures bill toward law before the inauguration.


Speculation on what a Trump administration will do on many fronts, particularly on ACA insurance, has for the health IT and healthcare delivery industry become focused on the future of value-based care payment models and population health management strategies upon the more recent nomination of Tom Price, MD (R-GA) as secretary of Health and Human Services.


This was the very topic of a three-day summit November 30 to December 2 hosted by the Jefferson College of Population Health and its dean David B. Nash, MD, MBA, FACP.


The summit brought together outgoing CMS Administrator Andy Slavitt, former HHS Secretary Michael Leavitt, former ONC Director Farzad Mostashari, NCQA President Peggy O’Kane, former advisors from the George W. Bush and Obama administrations, officials from Johns Hopkins, the Henry Ford Health System, Brookings, Deloitte, AMA, AHA, the American College of Physicians and many more to dissect MACRA and ponder “population health strategy under the new administration.”


Topics and predictions ranged from the Cadillac tax going the way of the DeSoto; Medicare Advantage payment models will increase; the overriding attention on ACA insurance will back-burner VBC changes buffered also by MACRA; Track1+ will itself be the savior of MACRA; and looming large is whether Medicare will become a voucher or premium support system.


It was noted that mandatory bundled payments may end, but then again bundled payments have returned nearly 3% to the Medicare Trust Fund, versus .02% by ACOs.


Former HHS Secretary Michael Leavitt sought calm. “CMMI will be challenged, but the analytics it provides are important to maintain … we need to find the balance between provider readiness and the speed to change between providers and payers … the GOP is not in lockstep … the bottom line is we don’t know.”

PTAC to the rescue

Given much attention at the conference was a so-far overlooked element of the MACRA law, the establishment of the Physician-Focused Payment Model Technical Advisory Committee (PTAC).


Amid speculation that the new regime at HHS will, again, decry mandatory bundled payments, shrink MACRA, lay siege to EHRs (which took its lumps from many quarters) and roll back the movement to VBC or quality reporting payment models seen as onerous to physician workflow, PTAC was seen as a potential fresh start.

Its mandate is to assess and put forth new physician-focused payment models, done by a committee of 11 already appointed by the GAO; a committee that includes six MDs. Already nine letter-of-intent proposals have been submitted, and PTAC is to refer winning payment model proposals to, yes, the new secretary of HHS by the spring of 2017.


These new payment models can be APMs, A-APMs, bundled payments; you name it. The criteria for them includes the use of health information technology, risk-level flexibility, value over volume, integrated care coordination and cost-quality metrics. Sound familiar?


The path is also clear to merge these new models, blessed by a new administration, into MACRA, because under MACRA implementation, new models are to be introduced and listed annually. That does mean Jan. 1, 2018 would the first look at what may come out of PTAC.

A Physician’s View

In the end, Bob Margolis, MD, Duke-Margolis Center for Health Policy, took a direct position. Physicians should take the debate out of Washington and into their own hands, and realize a future without a government single payer with price controls and salaried doctors.


How? Establish their own care plans around predictive modeling and population analytics. Consider a global capitated population health approach stratifying patients into appropriate treatment plans. Realize that EHRs are not tools for analytics and that BI tools are needed on top. And then, assessing risk-based payment models can be a holistic approach. He reminded the attendees that PCPs and their aligned specialists control 85% of the healthcare spend.


In Washington, D.C., that’s called power.

About the author

Greg Fulton

Greg Fulton,
Industry & Public Policy Lead, Philips

Greg Fulton is Industry & Public Policy Lead for Philips PHM. He has extensive health IT experience in government relations at Congressional, Health & Human Services, state and industry organizational levels. He is a current member of the CommonWell Health Alliance Government Affairs Advisory Council and the HIMSS Government Relations Roundtable.

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