NAACOS’s Robert Daley on Congress’s Options in Accelerating Value-Based Payment

July 6, 2023
Robert Daley, NAACO’S director of legislative affairs, looks at Congress’s options in moving to accelerate value-based payment, and ACOs’ role in APMs’ success to date

Leaders at the Washington, D.C.-based NAACOS (National Association of ACOs) have given Healthcare Innovation permission to republish NAACOS-published blogs, in order to inform the industry. In this blog, Robert Daley, NAACOS’s director of legislative affairs, begins with the June 22 House Energy and Commerce Oversight and Investigations Subcommittee hearing, and goes on to look at the near-term future of alternative payment models (APMs) and the relationship between APMs and the Medicare accountable care organizations (ACOs).


•            The House Energy and Commerce Oversight and Investigations Subcommittee held a hearing on June 22 to discussing implementation of the Medicare Access and CHIP Reauthorization Act.

•            Aisha Pittman, Senior Vice President of Government Affairs represented NAACOS at the hearing and answered questions about how ACOs are leading Medicare’s transition to alternative payment models (APMs).

•            In written testimony and during the hearing, NAACOS called on lawmakers to extend incentives for practices in APMs and discussed ways that Congress can improve Medicare’s payment system to advance value-based care.

Robert Daley, Director, Legislative Affairs, National Association of ACOs

Congress provided financial incentives for clinicians to transition to value-based care models in 2015 through the Medicare Access and CHIP Reauthorization Act, a law referred to as MACRA. It provided a 5-percent incentive payment to certain risk-bearing APMs, among other changes to Medicare’s payment structure for physicians. APMs encourage keeping patients healthy and improving quality, resulting in better care for patients and lower costs for taxpayers.

In the eight years since, the law has been a strong step in the right direction. ACOs account for the majority of Medicare’s advanced APMs, using incentives to hire care managers to provide personal care to their sickest patients, provide transportation and meals, invest in technology, and create 24-7 phone lines so patients can call their primary care provider rather than going to the emergency room. These are services that cannot be reimbursed through Medicare but improve patient health outcomes and wellbeing. In the last decade, ACOs have generated more than $17 billion dollars in savings with $6.4 billion being returned to Medicare, all while maintaining high quality for patients.

Now Congress is examining physician payment as a whole, including the success and weakness of MACRA. NAACOS Senior Vice President of Government Affairs, Aisha Pittman, testified before the House Energy and Commerce Committee last month to explain how ACOs are an increasingly critical part of our health system and how Congress can better support ACOs. Below is a summary of many of the key exchanges during last month’s hearing as well as NAACOS’s message to Congress.

What are lawmakers saying?

•            Rep. Morgan Griffith of Virginia, Chairman of the House Energy and Commerce Oversight and Investigations Subcommittee, kicked off questions by asking what factors have limited growth in APMs and what can be done to increase participation and get more models working. To encourage more providers to join APMs, Pittman said, “incentive payments have drawn more clinicians into the models. It’s a huge incentive when our ACO members go out and try recruiting practices. Talking about this incentive payment is really a way that brings more clinicians to the model.” APM incentives go directly to physician practices. This provides them with financial resources that allow them to innovate and expand patient care.

•            Rep. Cathy McMorris Rodgers of Washington, the Chairwoman of the House Energy and Commerce Committee, asked how to best help rural and specialty providers succeed under value-based payment arrangements. Pittman responded by highlighting how ACOs in Washington state can shift resources to the appropriate place and use technology to stay connected with patients. “To bring more rural providers in, we have to think about how to set the budget appropriately to address underserved populations,” Pittman said.

•            Rep. Kim Schrier of Washington highlighted how an ACO in her state used MACRA’s incentive payments to address a patients’ social determinants of health needs that would not have been covered under traditional Medicare. Pittman responded by discussing how advanced APM incentives are reinvested back into practices to improve patient care. As Congress looks at long-term reforms to encourage more participation in APMs, lawmakers should ensure that qualifying thresholds do not discourage specialist participation. Expanding incentives to more non-risk APMs will also encourage participation, especially among providers that serve rural and underserved patient populations. 

•            Rep. Gary Palmer of Alabama discussed concerns regarding the limited cost savings of Centers for Medicare and Medicaid Services (CMMI) models. Pittman responded by discussing how there needs to be more transparency around model development and how successful elements of demonstrations should be incorporated into Medicare’s permanent programs.

What’s next for MACRA and Medicare’s transition to value-based care?

While APMs are transforming how patients in traditional Medicare receive care, adoption of value models has been slower than originally predicted due to misaligned incentives, challenges in APM implementation, and time needed for clinicians and providers to redesign care processes. MACRA was a step in the right direction, but more needs to be done to drive long-term system transformation. NAACOS recommended Congress take the following actions to accelerate the adoption of value-based care going forward.

1)           Extend the 5 percent advanced APM incentives and give CMS the authority to adjust qualifying thresholds to promote growth.

2)           Redesign physician payment to ensure that clinicians receive adequate payment updates with any additional incentives reserved for clinicians who move into APMs.  

3)           Ensure participants join and remain in existing APMs by removing barriers that limit participation and giving additional flexibility and tools to innovate care.

4)           Work with the CMS Innovation Center to ensure that promising models have a more predictable pathway for being implemented and becoming permanent and are not cut short due to overly stringent criteria.

5)           Establish parity between APMs and Medicare Advantage to ensure that both programs provide attractive, sustainable options for innovating care delivery and that APMs do not face a competitive disadvantage.

NAACOS is working with our stakeholder partners and congressional champions to include many of these recommendations in an updated version of the Value in Health Care Act in the 118th Congress.

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