ACO Coalition Letter Supporting Value-Based Models by Allocating Additional Provider Relief Funds

August 13, 2020

 

The Honorable Nancy Pelosi                                                 The Honorable Kevin McCarthy
Speaker of the House                                                              Minority Leader
U.S. House of Representatives                                              U.S. House of Representatives
Washington, D.C. 20515                                                         Washington, D.C. 20515

The Honorable Mitch McConnell                                         The Honorable Chuck Schumer
Majority Leader                                                                        Minority Leader
U.S. Senate                                                                                U.S. Senate
Washington, D.C. 20510                                                        Washington, D.C. 20510

 

Dear Speaker Pelosi, Minority Leader McCarthy, Majority Leader McConnell, Minority Leader
Schumer:

The undersigned provider organizations, which strongly support the movement away from the
current fee-for-service (FFS) system toward value-based care, write to express appreciation for
the significant efforts underway by Congress to address the COVID-19 pandemic and to assist
clinicians and hospitals. As part of these efforts, we urge Congress to support health care
providers participating in value-based models by allocating additional provider relief funds to
assist their efforts to not only combat the COVID-19 pandemic, but to support their continued
to participation in value-based models.

Physicians and other providers have had to address numerous challenges during the pandemic
to continue safely caring for our patients and their families, with financial strain chief among
those challenges. Providers operating under FFS payments continue to face significant declines
in revenue as utilization rates declined sharply and suddenly and have not yet rebounded to
pre-pandemic levels. We greatly appreciate Congress supporting these physicians, and we
request that Congress also provide direct support for those operating under value-based
payment (VBP) models. The additional support is paramount in ensuring the continued shift
away from the fragile, non-resilient FFS payment model toward value-based, high quality care.

In many cases, clinicians participating in VBP models have been better positioned to respond to
the pandemic than those in FFS, especially when receiving prospective, predictable payments. A
survey conducted by Premier, Inc. found that more APM participants use population health
tools such as care management support, triage call centers, and remote monitoring to manage
the pandemic and prevent spread of COVID-19 than non-APM participants. One clinically
integrated network of over 1,000 independent primary care physicians located in Texas has
been able to leverage their value-based care capabilities to respond to the crisis. These
capabilities include proactive and planned care; implementing a centralized COVID-19 testing
center; leveraging population health data to manage and predict utilization; and using claims
data to understand care delivered outside of their network. In general, ACOs have experience
identifying vulnerable patients and have used that to identify those at high-risk for COVID-19.
They have also used their population management systems and other tools to educate patients
about minimizing exposure, make sure they have enough food and medication to stay home,
remotely monitor their underlying conditions, treat cases through telemedicine, and manage
post-discharge complications with integrated home health and effective relationships with
post-acute providers.

However, with many practices struggling to keep their doors open, clinicians will require
additional support if they are to continue to expand their participation in VBP to support
investments in telehealth, data sharing technologies, and enhanced care collaboration and
coordination. Therefore, we urge Congress to consider allocating additional provider relief
funds to specifically assist clinicians in continuing their efforts to not only combat the COVID-19 pandemic, but support and advance the movement to value based payment, specifically innovative payment models.

Additionally, we recommend that Congress solicit input from current VBP participants
regarding investment opportunities that would help to facilitate increased adoption of
Alternative Payment Models (APMs).

We urge Congress to support clinicians in APMs through this challenging time and consider
other innovative ideas to help providers move away from FFS payment, such as those
included in the Duke Margolis Center for Health Policy, Families USA, and United States of Care
proposalCOVID-19 Health Care Response and Resilience Program and the Value in Health
Care Act (HR 7791), a bill offering new payment structures that encourage high-value patient
care such as extending advanced APM incentive payments and modifying quality payment
thresholds to ensure advanced APM participants can continue to earn said incentives.

Our members are taking responsibility in improving the health of the patients and communities
they serve by holding themselves accountable for both cost and quality through APMs. This
positive movement to transform our system of care must continue along with the creation of
strong incentives for the delivery system to improve population health, quality, and the patient
experience. Continuing to move toward value-based care will make for a stronger healthcare
system infrastructure that will also be better equipped to handle future public health crises. It is
important that we support the movement away from the antiquated fee-for-service
reimbursement system to a system that focuses instead on the quality and efficiency of care
provided.

Sincerely,

 

American Academy of Family Physicians (AAFP)
America’s Physician Groups
Health Care Transformation Task Force (HCTTF)
National Association of ACOs (NAACOS)
Premier, Inc.

Cc: Honorable Members of the United States House of Representatives
Honorable Members of the United States Senate

 

Please click here to download a copy of the letter.