On Tuesday, Jan. 12, the leaders of the Los Angeles-based America’s Physician Groups (APG), a national association of the leaders of multispecialty physician groups participating in value-based contracting, called on the incoming Biden administration to accelerate the movement to value, strengthen the Medicare Advantage program to drive better value, and work to lower healthcare costs.
Their statement was clear and assertive, and one of the first of its kind published by a national healthcare professional association that was directed towards President-elect Joe Biden and his incoming cabinet. And it was early enough that we still hadn’t gotten to know who the incoming Administrator of CMS (the Centers for Medicare and Medicaid Services) will be.
A press release posted to APG’s website on Tuesday morning began with this statement: “America’s Physician Groups (APG) congratulates President-Elect Joe Biden, Vice President-Elect Kamala Harris, and his transition team on his election to the Presidency of the United States. In a letter to President-Elect Biden, APG recommends three key strategies to help his administration improve the quality of and access to our nation’s healthcare services: Accelerating budget-based prospective payment models, strengthening the Medicare Advantage program, and lowering healthcare costs through drug pricing reform and encouraging more at-home and ambulatory patient care.”
First, they urged the new president, vice president and their team to “accelerate the movement to value, stating that “Value-based models of care emphasize the delivery, measurement and outcomes of care as opposed to the current fee-for-service model that focuses on volume of services at the expense of cost and what is the best for patients. Innovative healthcare providers are successfully delivering improved patient care at lower costs through budget-based prospective payment models and these models must be recognized and supported. APG notes that if the Biden Administration drafts a plan for a public healthcare option, it recommends that a budget-based prospective payment system be used for physician groups.”
APG’s leaders have been on the front lines in emphasizing that providers can demonstrate that value-based contracting works. Indeed, one of the very best things that the incoming administration could do would be to figure out how to optimally spur forward the shift into value. The current administration has been sending mixed signals for some time now, demanding that providers take on substantially more two-sided or downside risk, yet not improving benchmarks and other key details involved in the Medicare Shared Savings Program (MSSP) that would encourage more providers to plunge into downside risk. With regard to promoting value-based care models, the best thing that President-elect Biden could do, along with incoming Secretary of Health and Human Services Xavier Becerra, once the U.S. Senate confirms his nomination, will be to name a CMS Administrator with plenty of experience, and someone who is both respected in the healthcare industry, and who will demonstrate vision and consistency.
The APG leaders’ second wish on their list is for “strengthening Medicare Advantage (MA) to drive better value.” They see MA as being the most tried-and-true alternative payment model (APM), and it certainly is that. Perhaps not everyone in the industry would agree that an overwhelming amount of energy should be put into enhancing MA; some would urge that more emphasis be put onto accountable care organization (ACO) programs, including the MSSP, or into direct contracting with physicians. But there is an argument that could be made—and APG’s leaders are making it—that MA, as the most established APM, should continue to be strengthened.
The APG leaders detail their thoughts behind their third wish-list item, “lowering healthcare costs,” stating that “Lowering the costs of care through drug pricing reform and transferring more patient care to ambulatory and home settings is a key piece of the value-based movement supported by APG.” It will be fascinating to see how quickly and comprehensively the incoming administration moves to prioritize the shift of care and care management into outpatient and home settings, a shift that has already been evolving forward organically, driven forward by the impatience of healthcare purchasers and payers with perpetually rising healthcare costs, and new technologies, both medical and information, that are making that shift more and more possible. Hospital-at-home programs are one example of that shift in action; but the incoming administration could help to turbocharge forward this important evolution.
What will be very interesting to see will be whether rifts might appear between the physician group and hospital system advocacy groups, once the new CMS Administrator is in place, and that individual sets the administration’s internal health system reform priorities. The balance that the new administration’s senior health policy leaders will need to aim for will be challenging to achieve. The devil really will be in the details.
But there is reason to hope for the best here, as there is a very good chance that the incoming administration will bring in experienced, thoughtful, and visionary leaders who will quickly determine the administration’s top priorities around federal health policy, and in particular, around internal health system reform. Of course, the incoming administration will be facing a welter of policy demands, with much necessary focus on the COVID-19 pandemic. But there are many possibilities for advancement and change; and it is a good exercise for organizations like APG to make their voices heard early on here.
