The Third Option
In response to physicians’ need for additional advanced APM options as well as to address the weaknesses of the fee-for-service accountable care organization (ACO) program, America’s Physician Groups designed a better ACO model, the Third Option. The Third Option features prospective, capitated payments, robust quality measurement, and active beneficiary engagement. In late 2017, we worked closely with members of Congress in both the House and Senate to submit a letter to CMS Administrator Seema Verma urging the agency to test a prospective, global payment ACO model that would qualify as an advanced APM under MACRA, on par with our Third Option model. In 2018, APG highlighted the Third Option in response to a Request for Information (RFI) issued by the Center for Medicare & Medicaid Innovation (The Innovation Center) on direct provider contracting (DPC) models and underscored the importance this forthcoming model will play in advancing the value movement.
We are pressing for this new model to push through this Administration such that direct, globally capitated contracts will be created between CMS and capable, quality physician groups like our APG members. Beneficiaries would be asked to actively enroll and select their own medical group that they already know and trust; differential cost-sharing strategies would incentivize them to stay in the network (i.e., “Point-of-Service” design). These would be qualifying alternative payment models (APMs) within MACRA and would basically correct the several glaring shortcomings in the Medicare Accountable Care Organization (ACO) program.
Strengthening and Protecting MACRA
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is central to the goal of moving away from our current fee-for-service reimbursement system, where providers are paid “per click” without an eye toward quality, cost or elimination of waste and toward a system that reimburses them based on the quality, efficiency, and patient outcomes. America’s Physician Groups is calling for timely MACRA implementation, with flexibility for expanded participation for a wide variety of clinicians at various stages of the transformation journey. There are opportunities to improve MACRA, and APG has been provided education and expertise on this front to Congress including sending APG members to the Hill to testify before Congress on improvements to both the advanced APM and MIPS portions of the law.
Promoting Parity between Traditional Medicare and Medicare Advantage
Our members recognize the importance of the care coordination tools MA provides both clinicians and patients. We have built an exceptional coalition of physician supporters for the program – now over 300 physician organizations strong. We successfully work with clinicians, associations, beneficiary groups, health plans, and others to improve MA funding and strengthen the program. Further, we believe that clinicians operating under MA plans that (1) bear more than nominal risk, (2) engage in robust quality reporting, and (3) utilize certified electronic health records should meet the requirements for Qualified Providers under the advanced APM track under the MACRA statute and thus be eligible for the five percent bonus on their traditional Medicare Part B revenue. In July, after years of APG advocacy on this issue, CMS announced the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which takes important steps to recognize the value these MA arrangements bring to the system, but doesn’t fully afford participants advanced APM status. APG will continue to work with the Administration and Congress to better integrate MA into MACRA and ensure that MA practitioners get the credit they are due for advancing value and lowering costs.