Washington, DC – U.S. Senators Sheldon Whitehouse (D-RI), John Barrasso (R-WY), Peter Welch (D-VT), Thom Tillis (R-NC), Bill Cassidy, M.D. (R-LA), John Thune (R-SD) and Marsha Blackburn (R-TN) yesterday introduced the Value in Health Care Act. The bipartisan legislation would update the program parameters of Medicare’s Alternative Payment Models (APMs) to incentivize participation in Accountable Care Organizations (ACO). The changes would increase participation in these value-based health programs, which are designed to improve the quality of care and health outcomes for seniors while lowering costs.
“Rhode Island’s accountable care organizations have led the nation at improving patient care while lowering health care costs. Patients are happy and providers are happy,” said Whitehouse. “Our bipartisan legislation will incentivize and encourage innovation in health care and help deliver coordinated, high-quality care to more seniors in Rhode Island and across the country.”
“As a doctor, I know how important it is for Medicare to provide our nation’s seniors with high quality care,” said Senator Barrasso. “We can all agree that value based Alternative Payment Models (APMs) are critical for the care of senior patients. Our bipartisan legislation will ensure these incentive-based programs remain in place to keep health care costs low and efficiency high for seniors in Wyoming and across the country.”
“It’s critical that Congress continues to work to improve patient care and reduce health care costs,” said Welch. “The Value in Health Care Act will ensure that providers in rural communities have meaningful incentives to participate in alternative payment models that will deliver high quality, coordinated health care for patients.”
“Value-based care programs have a successful track record of improving outcomes and reducing costs. The Value in Health Care Act will take an important step to further incentivize participation in these programs by financially rewarding coordination of care and patient outcomes, rather than the number of services provided,” said Senator Tillis. “I’m proud to join my colleagues in introducing this bipartisan legislation that will increase access to higher quality, lower cost, patient-centered care for the nearly two million seniors in North Carolina.”
The Affordable Care Act created the Center for Medicare and Medicaid Innovation, which was endowed with the authority to introduce APMs into Medicare and Medicaid. APMs have played a key role in providing high-quality care for Medicare beneficiaries while producing billions of dollars in savings for taxpayers over the past decade. However, rules implemented for ACO programs have limited the number of providers participating. The Value in Health Care Act helps maintain and further strengthen the movement towards value where financial performance is linked to the quality of patient care rather than the number of services delivered.
“ACOs have been a wise investment for our health care system that has proven to provide better patient care at lower costs,” said Clif Gaus, Sc.D., President and CEO, National Association of ACOs (NAACOS). “The Value in Health Care Act would maintain incentives that expand access for beneficiaries and support providers with the transition to value. This important piece of legislation should be part of Congress’s conversation to update physician payment and improve quality of care. We thank Senators Whitehouse and Barrasso for their continued leadership and look forward to working with lawmakers as they seek solutions that will improve the Medicare program.”
In Rhode Island, ACOs like Coastal and Integra/RI Primary Care Physicians have coordinated care to improve patient outcomes, support providers, and save Medicare money.
“We applaud Senator Whitehouse for introducing this legislation and for his stalwart support of ACOs that has changed the payment and patient care models across the country,” said Dr. Edward McGookin, President, Lifespan’s Coastal Medical. “The Value in Health Care bill is a momentous leap forward as it paves the way for more physician groups to successfully transition to value-based care while also encouraging broader participation in the Medicare Share Savings Program by reducing disincentives. Lifespan continues to appreciate Senator Whitehouse’s constant focus on patient-centered healthcare.”
“The Value in Health Care Act addresses many of the shortcomings of the current Medicare Shared Savings Program,” said Noah Benedict, MHL, President and CEO, Rhode Island Primary Care Physicians Corporation. “The Act refines the established financial model, commits to enhancing performance reporting, and allows providers to assume varied levels of risk responsibly. These improvements lead to greater model transparency and remove many barriers to program participation. This is a step forward in supporting providers through the transition from fee-for-service to value-based care, which is critical to the long-term sustainability of our healthcare system.”
“Integra strongly supports the Value in Health Care Act, which includes important changes that will enable ACOs, like Integra, to continue to innovate and invest in services that improve quality of care and outcomes for patients while also managing health care cost trends,” said Dr. Ana Tuya Fulton, Chief Population Health Officer and Executive Chief of Geriatrics & Palliative Care, Care New England Health System and Chief Medical Officer, Integra Community Care Network and Matthew Harvey, Executive Director, Integra Community Care Network. “The extension of the MACRA APM incentive payments is a critical investment in primary care that will enable our clinicians to continue to provide outstanding coordinated care. We also strongly support the other changes in the bill that, while they appear technical, have meaningful impact on the sustainability and operation of the Medicare Shared Savings Program (MSSP), particularly the option for full risk in MSSP and the study to understand the impacts of APM and MA and to ensure alignment between these programs. We are grateful to Senator Whitehouse for his leadership and support of value-based care.”
The Value in Health Care Act would make the following changes to the APM and ACO parameters:
- Incentivize participation in Advanced APMs by extending the annual lump sum participation bonus for an additional two years.
- Correct arbitrary thresholds for Advanced APM qualification to better reflect the existing progress of the value-based movement and to encourage bringing more patients into this model of care.
- Establish guardrails for CMS to ensure that the process to set financial benchmarks is transparent and appropriately accounts for regional variations in spending to prevent arbitrary winners and losers.
- Remove barriers to ACO participation by eliminating arbitrary program distinctions so all participants are participating on a level playing field.
- Support fair and accurate benchmarks by modifying performance metrics so participants aren’t competing against their own successes in providing better care.
- Provide greater technical support to ACO participants to cover the significant startup costs associated with program participation.
The Value in Health Care Act is endorsed by the American Hospital Association, American Medical Association, Accountable for Health, American Academy of Family Physicians, American Academy of Orthopedic Surgeons, American College of Physicians, America’s Essential Hospitals, America’s Physician Groups, AMGA, Association of American Medical Colleges, Federation of American Hospitals, Healthcare Leadership Council, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs, National Rural Health Association, and Premier Inc.
Companion legislation was introduced in the U.S. House of Representatives by Representatives Darin LaHood (R-IL), Suzan DelBene (D-WA), Brad Wenstrup, D.P.M. (R-OH), Earl Blumenauer (D-OR), Larry Bucshon, M.D. (R-IN), and Kim Schrier, M.D. (D-WA).
A section-by-section summary of the bill is available here.
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Meaghan McCabe, (202) 224-2921
