Accountable Care, ACO, Affordable Care Act

Meet the Next Generation ACO Cohort

by Gregg A. Masters, MPH

As announced in ‘Next Generation ACOs: A Deep Dive Serieswe’re launching a multimedia (blog, internet radio, social media and community tweetchats) programming schedule that will focus on the accountable care industry with specific deep dives into select participants in the cohort admitted by the Center for Medicare and Medicaid Innovation.

Next Generation ACO Model

Written versions of those interviews will post on ACO Watch, with audio versions featured on This Week in Accountable Care’ on the BlogTalk Radio and Affiliate Networks.

If you are interested in the Next Generation ACO Model, see: The Next Generation ACO: Accelerating the Transformation from Volume to Value and the CMS Webinar: Next Generation ACO Model – Overview and LOI Information with key webinar dates and application deadlines.

For those interested in learning more about the rather ‘eclectic’ (academic, physician led, hospital system sponsored and venture backed) class of 44 ACOs in the NextGen Cohort, I’ve listed them below: 

We intend to host monthly moderated ‘tweetchats’ to engage the community of stakeholders via #ACOchat and welcome your input on the preference of the participating ACOs you’d like us to profile.

Please post in the comments section.

Cheers!

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*Editor’s Note: This post including This Week in Accountable Care broadcasts, periodic tweetchats via #ACOchat and blog posts in this series) are sponsored by National ACO, a Next Generation ACO. For more information on National ACO, click here.

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Accountable Care, ACO, Affordable Care Act, health reform

The Quality Payment Program

by Gregg A. Masters, MPH

In our healthcare innovation economy from the private sector to material modifications of public programs including Medicare and Medicaid there is a massive effort to identify and enable sustainable delivery and financing schema to stem the treasury bleeding and inch however incrementally towards ‘universal coverage’.CMS QPP 2

Ideological talking points opposing ‘Obamacare‘ aka the Affordable Care Act (ACA) notwithstanding, there are tangible efforts to move the needle in play while the uncertainty of a successor to the ACA remains largely ‘on the come’.

Continuing on this post ACA momentum, the Centers for Medicare and Medicaid recently weighed in on the ‘Quality Payment Program‘. Acting Administrator Andy Slavitt provides introductory remarks and is followed by his CMS colleagues who provide deeper dives into the QPPs two track choices: the Merit Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM).

To listen to the complete call we’re rebroadcasting it on ‘This Week in Health Innovation.‘ It is archived for on demand replay.

The associated deck is here, and the session transcript is here.

Original link to CMS QPP is here.

 

 

Accountable Care, ACO, Affordable Care Act, TrumpCare

TrumpCare: As the Puzzle Emerges…

by Gregg A. Masters, MPH

As the Trump administration takes form via the nomination of Rep. Tom Price to ‘steward’ (or decimate) the massive bureaucracy of the Department of Health and Human Services (HHS) with Seema Verma nominated as Administrator of the Centers for Medicare and Medicaid Administration (CMS) the structural touch-points to manifest the ‘repeal and replace‘ agenda of the Affordable Care Act (ACA) may be materializing before our eyes.

medscape_physician_survey2016Dr. Tom Price a Board Certified Orthopedic Surgeon (Editor’s note: the highest paid specialty per Medpage 2016 physician compensation survey and according the the Georgia Combined Board of Medical Examiners a ‘non participant’ in Georgia’s Medicaid program, with zero reported hospital appointments, publications or settled professional liability claims) and a vocal opponent of the ACA with several bills sponsored to enable ACA’s repeal and replacement is no friend of Medicare, Medicaid nor the broader ecosystem enabling the fulfillment obligations of the U.S. healthcare ‘[non]system‘.

Much of this likely health policy directional pivot can be reasonably visioned though the lens of what’s emerging as indicia of ‘TrumpCare‘ – the probable repeal and replacement option for ‘ObamaCare‘ aka the ACA.

In order to drill into what we can expect from President-elect Trump and the leadership team he’s proposed to assemble in order to drive his presumptive health reform vision we need focus on Rep. Tom Price’s historical positions and statements as potential replacement options.

The umbrella policy framework for for what may emerge as ‘Trumpcare’ begins at ‘Great Again‘ the .gov website dedicated to the President-elect’s agenda, and informed viaA Better Way (aka RyanCare) the Republican version to substitute ‘Government controlled‘ healthcare with so-called ‘free market‘ alternatives.

[Editor’s Note: At the bottom of this post we list a series of recent links associated with relevant health reform conversations].

Perhaps the most useful insights as to what is likely to survive the political consideration process is sourced from the collection of Republican authored repeal and replace proposals sourced from the historical work of Representative Tom Price.

At a June symposium organized by the American Enterprise Institute (AEI), Rep. Price, who serves as Chair of the House Budget Committee previewed his vision of healthcare reform with the following summary statements:

‘the ACA violates all of the principles that all of us hold dear…. accessible, affordable, a system of the highest quality and a system that provides choices for the American people – for patients.’

‘What we have put together is a patient centered plan that respects those principles. That allows everybody to have access to the coverage that they want not what the government forces them to buy.’

‘To solve the insurance challenges of portability and pre-existing and to save hundreds of billions of dollars.’

‘A few specific examples I’d like to share with you…

‘the individual and small group market – those of you who recognize or are in that area [Editor’s Note: code-speak for special interest groups including brokers, agents, MGAs and underwriters] you appreciate that its been ‘destroyed’ [Editor’s Note via essential health benefits, no preexisting conditions, mandatory MLR ceilings, removal of lifetime caps and the individual mandate] and so we want to re-constitute that market and make it responsive to patients and allow them to purchase the kind of coverage that they want [Editor’s Note: via a return to ‘junk insurance’ and ‘mini-med’ policies] not what the government forces them to buy [Editor’s Note: on the exchanges or via ACA sanctioned group health policies].’

‘Second we waste hundreds of billions of dollars [Editor’s note: estimated at a $55.6 Billion Price Tag Large, But Not a Key Driver of Total Health Care Spending] …due to lawsuit abuse in this country, the practice of defensive medicine and instead of just putting a band-aid on it, we propose a bold and robust solution that would allow physicians through practice guidelines [Editor’s note: Evidence Based Medicine, or so-called “cookbook medicine” by the AMA] to basically have a “safe harbor” [Editor’s note legal CYA] if your doctor does the right thing for a given diagnosis or given set of symptoms then they ought to be able to use that as an affirmative defense in a court of law – that’s the kind of proposal that we put forward.’

‘And third in addition the healthcare system that works for patients is one the must respect the physician patient relationship [Editor’s note: typically third party disintermediated practice, i.e. direct practice, concierge medicine, retainer or membership models] and so what we do is incentivize the highest quality of care without bureaucratic intervention. This better way, this plan right here that puts forward positive commonsense solutions for Medicare, Medicaid and for the larger healthcare arena so that we respect the principles of accessibility, of affordability of quality and of choices…’

There is so much fluff here we decided to do a deep dive on ‘PopHealth Week‘ with healthcare thought leaders and former health system and JV enterprise operators Fred Goldstein, Douglas Goldstein and Gregg Masters. We weighed in on some of the provisions of Representative Price’s tantalizing offers to the American people to deliver a viable alternative to the ACA that:

‘allows everybody to have access to the coverage that they want not what the government forces them to buy;

solves the insurance challenges of portability and pre-existing; and

saves hundreds of billions of dollars.’

You be the judge! Or as some may be recently awakening to: ‘Republicans suddenly discover that Obamacare repeal might not be so awesome, after all‘ or ‘Senate GOP Tips Its Hand: An Obamacare Replacement Could Be A Long Way Off‘.

If like me you are interested in how this unfolds I encourage you to follow the conversation on twitter via #PriceWatch and #TrumpCare hashtags.

More will no doubt be revealed! Some earlier context here and here.

Let’s drain the swamp, after all we now what works!

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Trumpcare Resources c/o Fred Goldstein:

https://www.donaldjtrump.com/positions/healthcare-reform

http://www.cbsnews.com/news/what-will-trump-do-about-obamacare/

http://www.politico.com/story/2016/11/obamacare-defenders-vow-total-war-231164

https://www.govtrack.us/congress/bills/114/hr3762/summary

http://healthaffairs.org/blog/2016/11/09/day-one-and-beyond-what-trumps-election-means-for-the-aca/

http://www.commonwealthfund.org/publications/blog/2016/nov/challenges-for-president-elect-trump-and-congress?omnicid=EALERT1125198&mid=fgoldstein@accountablehealthllc.com

https://www.greatagain.gov/policy/healthcare.html

http://www.dailykos.com/story/2016/10/23/1584745/-Paul-Ryan-has-three-great-ideas-to-improve-Obamacare

http://www.theatlantic.com/health/archive/2016/11/our-bodies-our-trump/507131/

https://www.greatagain.gov/policy/healthcare.html

http://www.commonwealthfund.org/publications/blog/2016/nov/challenges-for-president-elect-trump-and-congress?omnicid=EALERT1125198&mid=fgoldstein@accountablehealthllc.com

http://www.dailykos.com/story/2016/10/23/1584745/-Paul-Ryan-has-three-great-ideas-to-improve-Obamacare

https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donald-trump-is-beginning-to-face-a-rude-awakening-over-obamacare/

http://www.nationalreview.com/article/442120/obamacare-repeal-republicans-should-ensure-health-care-reform-bipartisan

http://blogs.wsj.com/briefly/2016/11/10/5-questions-about-affordable-care-act-coverage-after-donald-trumps-election/

http://www.johnsoncitypress.com/News/2016/11/13/What-would-health-care-look-like-under-Trump.html?ci=stream&lp=1&p=1

http://www.wsj.com/articles/donald-trump-willing-to-keep-parts-of-health-law-1478895339

http://www.healthcaredive.com/news/speculations-swirl-around-trump-hhs-leadership-pick/430301/

https://www.sciencebasedmedicine.org/medical-science-policy-in-the-u-s-under-donald-trump/

http://thehealthcareblog.com/blog/2016/11/13/dear-mr-president-elect-about-that-ryan-plan-thing/

http://www.modernhealthcare.com/article/20161111/NEWS/161119989?utm_source=modernhealthcare&utm_medium=email&utm_content=20161111-NEWS-161119989&utm_campaign=mh-alert

http://www.hhnmag.com/articles/7843-health-reform-and-the-trump-white-house-implications-for-key-stakeholders?utm_campaign=111516&utm_medium=email&utm_source=hhndaily&eid=254508792&bid=1588113#.WCsKPQk6jpM.twitter

http://www.politico.com/tipsheets/politico-pulse/2016/11/obama-dares-gop-on-obamacare-do-it-better-than-me-217419

http://www.vox.com/2016/11/17/13626438/obamacare-replacement-plans-comparison

http://www.wnd.com/2016/11/7-keys-to-effective-health-care-overhaul/

http://www.nationalreview.com/article/442529/obamacare-donald-trump-repeal-replace-tax-cuts

 

Accountable Care, Affordable Care Act, health insurance reform

CMS Quality Measure Development Plan: A DRAFT

by Gregg A. Masters, MPH

An inspirational leader and ‘disruptive‘ politician taken down well ahead of his time once opined:

“Ask not what your country can do for you, ask what you can do for your country…” John Fitzgerald Kennedy

Fast forward some 55+ years and season such an invitation with the relentless drone of 24/7/365 faux patriotism, hate mongering, intolerance, and emotive ‘hell no‘ sound-bytes proferred by those who self righteously claim title to the ‘take back our country’ narrative and you may ask yourself how did we get from there (the Peace Corps) to here (carpet bomb em)?

Yet, in our unique strain of American democracy even through studies empirically demonstrate a consistent disconnect between what Americans want and what their representatives codify via policy with a capital ‘P’, the bottom line is look in the mirror ‘we are the government’.

CMS_quality_development_planWhether it’s the creation and passage of what merged into the ‘Affordable Care Act‘ (ACA) or how the ‘public’ participates in both the legislative process and its implementation via the rule making process initiated aka the ‘notice of proposed rule making’ (NPRM), we are presented with both the opportunity and as it turns out obligation to engage in and thus granularly shape (via a dialectical bottoms up vs. top down exchange) the ground rules which in turn govern our economy and the conduct of its constituent industry stakeholders.

In the quest to advance the efficacy of quality initiatives (garbage in garbage out) one recent effort is the DRAFT release of the ‘CMS Quality Measure Development Plan: Supporting the Transition to the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models‘.  

As an industry we are process oriented sometimes to a fault. Moreover the ‘check the box’ or drop down nature of many of these measures lends itself to the argument that the state of the industry to actually measure, document and report healthcare quality is at best a crude representation of what is actually going on. Clearly there is more work to be done if this industry is to matter.

To help readers of this blog, the introduction of the executive summary is pasted below:

I. Executive Summary

Background

A transformation of the U.S. healthcare delivery system gained momentum in 2010 with the passage of the Patient Protection and Affordable Care Act (Affordable Care Act).1

The law established the Health Insurance Marketplace to extend consumer access to affordable care through private payers and provided strong incentives in publicly financed healthcare programs to connect provider payment to quality of care and efficiency. 

Building on the principles and foundation of the Affordable Care Act, the Administration announced a clear timeline for targeting 30 percent of Medicare payments tied to quality or value through alternative payment models by the end of 2016 and 50 percent by the end of 2018.
These are measurable goals to move the Medicare program and our healthcare system at large toward paying providers based on quality, rather than quantity, of care.2

The passage of the Medicare Access and Children’s Health Insurance Program (CHIP)
Reauthorization Act of 2015 (MACRA)3 supports the ongoing transformation of healthcare delivery by furthering the development of new Medicare payment and delivery models for physicians and other clinicians. Section 102 of MACRA4,i requires that the Secretary of Health and Human Services develop and post on the CMS.gov website “a draft plan for the development of quality measures” by January 1, 2016, for application under certain applicable provisions related to the new Medicare Merit-based Incentive Payment System (MIPS) and to certain Medicare alternative payment models (APMs).

The law provides both a mandate and an opportunity for the Centers for Medicare & Medicaid Services (CMS) to leverage quality measure development as a key driver to further the aims of the CMS Quality Strategy:

• Better Care,
• Smarter Spending, and
• Healthier People. 5

Measure Development Plan Purpose
The purpose of the CMS Quality Measure Development Plan (MDP) is to meet the requirements of the statute and serve as a strategic framework for the future of clinician quality measure development to support MIPS and APMs. CMS welcomes comments on this draft plan from the public, including healthcare providers, payers, consumers, and other stakeholders, through March 1, 2016.ii The final MDP, taking into account public comments on this draft plan, will be posted on the CMS.gov website by May 1, 2016, followed by updates annually or as otherwise appropriate.i

So here it is… have at it. Perhaps your input will in fact shape the substance and steward the glide-path of how the transformation from volume to value can be realized. Certainly it’s worth your consideration. Afterall, another attributed Kennedy quote with biblical DNA may apply here:

“We are not here to curse the darkness, but to light a candle that can guide us through the darkness to a safe and sure future. For the world is changing. The old era is ending. The old ways will not do.

The problems are not all solved and the battles are not all won and we stand today on the edge of a New Frontier – a frontier of unknown opportunities and perils, a frontier of unfulfilled hopes and threats.

It has been a long road to this crowded convention city. Now begins another long journey, taking me into your cities and towns and homes all over America.

Give me your help. Give me your hand, your voice and your vote.”

John Fitzgerald Kennedy

Accountable Care, population health, Triple Aim

ACOs and Population Health: The Value Narrative

by Gregg A. Masters, MPH

Before there was ‘accountable care’, the current full court press towards innovation – whether digital health app, platform or service delivery model, an emerging culture of transformation or the attendant pursuit of the triple aim, not to mention the most recent obsession with ‘retail as cure’ for that which ails healthcare, the best and the brightest minds (both clinical and administrative guided by thoughtful health policy wonks) convened in the grand theater of ‘managed care’ or managed competition.

The model and industry writ large (both public and private sectors), variably expressed as HMO, PPOs and derivative strains of contracting models stimulating the development of IPAs, PHOs, PPMC’s, MSOs and DPOs (direct purchasing organizations) had a run from the mid 70s until its abandonment as the official vehicle to restrain the rising cost and variable quality of healthcare in the late 90s. What followed was somewhat of a meandering decade of incremental tweaks here and there to an otherwise burning platform of fee-for-service healthcare delivery and financing.

In 2015 with healthcare costs now approaching 20% of the U.S. Gross Domestic Product and the viability of the entire U.S. Government at risk to projected costs increases and unfunded liabilities of the Medicare and Medicaid programs (estimated at $64 trillion), business as usual fee-for-service medicine is no longer an option and the many cathedrals of medicine built by ‘do more to earn more’ largesse are clearly at risk in the shifting sands of value based care.

While the ‘value’ v. volume agenda has been around for a while via risk based contracting including case rates, bundled payment and even capitation – both global and professional only versions – their penetration of mainstream medicine was relatively modest – until now. That is if you can believe the growing prevalence and penetration of risk bearing ACOs arrangements, a tapestry of bundled payment participation via Federal programs and a less transparent portfolio of privately negotiated ‘value based arrangements’.

Into this theater steps one of the trophy consulting companies with both wide (global) and deep (extensive client penetration into the health plan, provider and IDN communities) aka Accenture Health (follow via @AccentureHealth).

value based care meklausInto this developing narrative with a ‘value tutorial’ of sorts steps Gerry Meklaus, the Managing Director of Accenture North America for Clinical & Health Management Services. We speak with Gerry Wednesday at 12 Noon Pacific/3PM Eastern at Pophealth Week where my colleague and co-founder Fred Goldstein, President of Accountable Health, LLC will engage Gerry in the value conversation and the many touch points between a value framework for ACOs and population health strategies of provider organizations.

Key terms to un-bundle and digest are the ‘BIG Three’: 1) to ‘improve outcomes’ via emerging best practices, the reduction in variation and effective engagement of the patient in shared decision making, 2) the effective lowering of costs from a ‘total cost of care’ perspective (not just niche wins – if you will), and 3) the well known challenge to de-silo the many silos in the healthcare ecosystem driving fragmentation, redundancy and a less than patient centric experience.

Join us as we gain insight into the challenges and successes in the market to date!