Jan 16 2024 52 mins
We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing. Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs.
Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health. She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models.
Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value. And make sure to tune in to Mara’s special announcement about Health Care Value Week at the end of the interview so you don’t miss out on important educational events occurring January 29th thru February 2nd.
Episode Bookmarks:
01:30 The need for accountable care policies that create better health outcomes and patient experiences.
02:00 Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH
03:00 Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event).
06:00 How A4H is translating thought leadership to action in the advocacy arena.
06:30 Accountable care as the solution to fragmented, uncoordinated care.
07:00 Political turnover in D.C. has made VBC a “new” health policy solution.
07:30 Educating the Hill comes down to conveying enthusiasm for health care transformation.
08:00 Accountable for Health Members are shaping the national conversation for payment and delivery system reform.
09:00 The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH).
11:30 If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism?
12:00 The need to overcome misunderstandings about what ACOs are trying to achieve.
13:00 Providing education to dispel the myth that ACOs can actually limit services.
14:00 How uninformed policy decisions could potentially create a catastrophic blow to the value movement.
14:45 “Accountable care is integral to care delivery system reform.”
15:45 Confusion with the term “value-based care” and why it will fail unless people understand the truest aims of the movement.
17:00 The need for effective storytelling to advance care delivery transformation.
18:00 Prioritizing care experience over cost reforms (delivery innovation will address costs!)
20:00 The topline takeaways from CMS model evaluations and whether or not programs should be expanded.
21:00 What do most people think when they hear the word “value”? (the need to reframe the conversation with more precise language)
22:00 The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement.
24:00 Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking).
25:30 How strong relationships between MA plans and provider networks (underpinned by capitation) drive value.
26:30 Understanding provider compensation in MA value-based payment and the synergies between managing MSSP and MA populations.
27:00 Rethinking supplemental benefits in Traditional Medicare.
28:00 An overview of the Medicare Access and CHIP Reauthorization Act (MACRA).
30:30 The “cliff effect” of the Advanced APM Bonus reductions (and why that threatens the value movement).
31:30 “We need strong incentives to continue this work in accountable care transformation. The Advanced APM Bonus has built important momentum.”
32:30 The MIPS program maximum bonus is at 9% — in what world would the Advance APM incentive make sense at only 0.5%?
33:00 Why are providers in the last year earning full bonuses in MIPS when 2-3% has been the historical average?
33:30 An overview of The Value in Health Care Act of 2023 and consideration of a full-risk ACO option in the MSSP.
35:45 The need for a long-term vision for MACRA (i.e. MACRA 2.0).
38:45 The integration of specialists in accountable care models.
39:30 Leveraging the physician fee schedule as a glide path for specialist adoption. Providing data to ACOs to better engage specialists.
41:00 The responsibility of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to advance specialty-specific APMs.
41:45 The move to mandatory payment models to catalyze healthcare cost savings goals for CMMI.
45:00 How are Medicare-value based efforts aligning with Medicaid transformation?
47:00 Health Care Value Week is a week of action from January 29th to February 2nd, providing broad-based education on VBC.
48:30 The Virtual Value-Based Payment Summit is open to everyone (free registration) and the speaker lineup is incredible!
49:30 A4H’s Health Care Value Week Conference in D.C.on Feb. 1st to celebrate the progress of VBC in improving people’s lives!
51:00 Learn more about A4H and sign up for their newsletter at accountableforhealth.org.