Press Releases

Today, Representatives Suzan DelBene (WA-01), Peter Welch (VT-At-large), and Darin LaHood (IL-18) introduced the Value in Health Care Act, a bipartisan bill that will make commonsense changes to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The bill specifically amends many of the program parameters of Medicare’s Alternative Payment Models (APMs). The changes will increase participation in these value-based health programs that are designed to improve the quality of care and health outcomes for seniors while lowering costs. 

In 2017, a U.S. Health and Human Services Inspector General report found that 98 percent of Accountable Care Organizations (ACO), after participating for three years, met or exceeded quality measures and outperformed regular fee-for-service providers on 81 percent of quality measures. In 2018, which is the most recent available data, ACOs average quality score was 93 percent. An independent analysis found that between 2013-2017 ACOs collectively lowered spending by $3.53 billion and garnered $755 million in savings for Medicare. The ACO model under the Medicare Shared Savings Program serves nearly 11 million seniors and is Medicare’s dominant value-based care model. In 2019, after implementing program updates to Medicare’s ACO program, fewer ACOs participated for the first time since its inception in 2012.

The Value in Health Care Act makes the following changes to the APM and ACO parameters:

• Encourages participation in the Medicare ACO program by increasing the percent of shared savings beginner participants receive. Recent program changes decreased shared savings, making the program less attractive.
• Modifies risk adjustment to be more realistic and better reflect factors participants encounter like health and other risk variables in their communities.
• Removes barriers to ACO participation by eliminating arbitrary program distinctions so all participants are playing 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. 
• Provides greater technical support to ACO participants to cover the significant startup costs associated with program participation.
• Incentivizes participation in Advanced APMs by extending the annual lump sum participation bonus for an additional six years.
• Correcting 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.
• Addresses overlap in value-based care programs so that APM overlap within markets complement each other rather than cause confusion.

“Physicians and hospitals participating in APMs are driving the change in health care we so desperately need. The Value in Health Care Act makes sensible modifications to the existing APM parameters and encourages more providers to participate. This ultimately helps seniors by improving the quality of care and outcomes,” said DelBene. “The ACOs in Washington are doing the right thing by making sure seniors, who are isolating to protect themselves from COVID-19, are accessing nutrition and pharmaceutical prescriptions. This is the exact kind of care coordination that we need – it’s even more critical during the public health emergency.”

“To increase the quality of care across the country we need to encourage value, not volume,” said Welch. “These commonsense changes will reward providers for delivering the value that patients need and expect. ACOs deliver better care for a better price, and we need to do everything we can to make sure that they succeed.”

“The Value in Health Care Act is a commonsense proposal that includes substantive reforms to encourage and support greater participation by health care providers in ACO’s, particularly in our rural communities in central and west-central Illinois,” said LaHood. “By incentivizing the use of these value-based health programs that support coordinated care between doctors, hospitals, and other health care providers, this legislation will improve health care access and the quality of care for our seniors, which is critical now in our fight against COVID-19. As we continue to battle this virus, I am committed to working with my colleagues to get this bill passed to support our communities and seniors in IL-18.”

Under MACRA, providers participating in quality improvement programs can choose between an APM or the Merit-Based Incentive Payment System (MIPS). Both programs incentivize providers to improve quality, outcomes, and cost containment.

A section-by-section of the bill can be found here. The full bill text is available here.