AMGA Leaders: Once COVID Relief Is in Place, the Healthcare Policy Discussion Will Shift to Value

Feb. 12, 2021
Leaders at AMGA, which represents large multispecialty medical groups—see the federal healthcare policy discussion shifting back towards the dialogue around value, once COVID-19 relief is in place

At the end of November, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed three senior leaders of the Alexandria, Va.-based AMGA (American Medical Group Association)— Chet Speed, chief policy officer; Jamie Miller, senior director, government relations; and Darryl Drevna, senior director, regulatory affairs, regarding the current moment in federal healthcare policy development, as part of preparation for the January/February cover story, which included the results from our 2021 State of the Industry Survey. As noted on its website, AMGA represents more than 175,000 U.S. physicians working in large multispecialty group practices nationwide, and caring for one in three Americans. The interview took place after the presidential election but before the inauguration of President Joe Biden. Below are excerpts from that interview.

What does the next 24 months look like, in terms of policy around payment innovation?

Jamie Miller: From a value perspective, as you know, Congress and the administration spent over $3 trillion on COVID and will spend some more, and our members will be leading innovation, and I think the medical group model is the way towards the future of medicine, and we’re just going to continue to promote the medical group model. And going forward, there’s obviously going to be a lot of discussion about how our system progresses.

Darryl Drevna: There are two things going on here. One, AMGA and its membership will continue to go towards value-based and population health-based models, because there’s really no alternative. That said, what HHS [the Department of Health and Human Services] is going to do will depending on who’s staffing HHS, and how we come out, post-pandemic, and what our capacity is. We’re going to keep moving ahead, and I’m going to be working to make sure that HHS and Congress see us.

With regard to telehealth, one of the questions hanging over the industry for several months now, since CMS [the Centers for Medicare and Medicaid Services] relaxed a variety of regulations around telehealth-based reimbursement, has been whether some of those relaxations will be extended once the public health emergency is declared over [President Biden in January signed an executive order extending the emergency until the end of the year]. Among the key questions remain around payment for any originating site of care, and payment parity. What are your thoughts?

Miller: It’s complex, but when you talk individually to members of Congress, they’re all talking with us and realize that it’s a problem that needs to be addressed. We’ve talked to a lot of members on both sides of the aisle, and they also want to promote telehealth beyond the public health emergency, and that’s bipartisan.

Do you think that payment parity for telehealth will continue beyond the public health emergency?

Miller: When we talk to our members and they talk about this being the new norm, and they’ve invested in infrastructure to ensure that, our position is that we want that coverage to extend beyond the emergency.

Is it CMS or Congress that will extend this?

Drevna: They both did. CMS at the beginning of the pandemic, issued some emergency regulations that waived some telehealth restrictions to they extent they could, and Congress then passed legislation to give them more authority, so CMS put out a second interim final rule to modify the telehealth regs, all linked to the declaration of the public health emergency. When that declaration goes away, though I don’t think it will anytime soon, those elements will go away, so it will take congressional action.

Miller: Seema Verma has been very bullish on telehealth, and our members have invested a lot in time, effort, and treasure in telehealth; and there’s a lot of support in Congress for that. So we need to work out what’s appropriate for telehealth versus face-to-face. So there’s a move to make the waivers permanent soon or at least to extend the waivers for a while, while developing appropriate payment waivers for it.

What does the next 24 months look like, in terms of policy around payment innovation?

Miller: From a value perspective, as you know, Congress and the administration spent over $3 trillion on COVID and will spend some more, and our members will be leading innovation, and I think the medical group model is the way towards the future of medicine, and we’re just going to continue to promote the medical group model. And going forward, there’s obviously going to be a lot of discussion about how our system progresses.

Drevna: There are two things going on. One, AMGA and its membership will continue to go towards value-based and population health-based models, because there’s really no alternative. That said, what HHS is going to do will depending on who’s staffing HHS, and how we come out, post-pandemic, and what our capacity is. We’re going to keep moving ahead, and I’m going to be working to make sure that HHS and Congress see us.

Chet Speed: For the next six months, it will be all about COVID-19 and survival; but in the next 24 months, it will be about value.

Once all the key legislation around COVID-19 relief has been passed, would you agree that the shift into value is inevitable, then?

Speed: Yes, and if you were fee-for-service-payment-based, your volumes stopped under COVID [during the first quarter of 2020, when elective procedures were stopped]. And fee-for-service payment is still the dominant payment system in the country, but even though value-based care delivery is something our members all embrace, it requires significant clinical, financial, and operational redesign. Our members are all committed to it, but it’s not easy; it’s very complex, and takes time. And the payers have to follow suit as well.

Will the payers move forward more quickly on value-based contracting in the next couple of years?

Speed: They say they’re doing so. Most of their statements indicate the desire to move more quickly towards value-based arrangements. Some payers truly are committed; Humana certainly is. And Aetna’s got an ACO [accountable care organization] program with Cleveland Clinic. So they’re moving there, so I wouldn’t say it’s a full commitment yet. A great story would be to talk to payers, providers, and purchasers about this. If you talk to the head of HR for a major employer, they’ll say, value sounds good, but our employees demand access. So the move to value sounds good.

Is this train headed more towards the narrowing of networks or towards the forcing of value at the level of individual clinicians?

Speed: Finance drives behavior. So some payers are developing incentive-based contracts with individual providers, so that the financial arrangement will drive value through that contract. And that does get down to the individual clinician level of performance. There are a lot components to this.

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