Press Releases

Today, Representatives Suzan DelBene (WA-01), Markwayne Mullin (OK-02), Ami Bera, M.D. (CA-07), Mike Kelly (PA-16), Peter Welch (VT-At-Large), Darin LaHood (IL-18), and Brad Wenstrup (OH-02) led a bipartisan effort calling on U.S. Department of Health & Human Services (HHS) Secretary Xavier Becerra to deliver better health outcomes for seniors by increasing incentives for value-based care.

In a letter from 41 lawmakers, the group asks Becerra to make commonsense modifications to the Medicare Shared Savings Program (MSSP) and implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) that already have strong bipartisan support in Congress and will increase provider participation in alternative payment models (APMs). APMs hold providers accountable to deliver better health outcomes for their patients while driving down costs.

“Adoption of value-based payments has played a critical role in slowing health care spending while improving quality over the last decade,” the lawmakers wrote. “Moving forward, we must continue to prioritize policies that incentivize responsible cost-savings and advance quality care for seniors, as intended by Congress.”

In 2018, CMS made changes to Medicare’s Accountable Care Organization (ACO) program that resulted in a 15% drop in participation. The letter asks that several of these changes be reversed.

In 2021, the Centers for Medicare & Medicaid Services (CMS) within HHS made it a goal to have every Medicare beneficiary in a value-based program by 2030.

The lawmakers outline six specific actions HHS can take to increase participation in APMs and help achieve its 2030 goal:

• Encourage participation in the MSSP by restoring the percent of shared savings beginner participants receive to at least 50 percent.
• Modify risk adjustment to be more realistic and better reflect factors participants encounter, like health and other risk variables in their communities.
• Remove the arbitrary high- and low-revenue ACO distinction so that all participants are on a level playing field. No ACO should be required to take on more risk than the nominal risk standard set by CMS.
• Establish fair and accurate benchmarks by modifying performance metrics so participants aren’t competing against their own successes in providing better care.
• Address overlap in value-based care programs so that APMs within markets complement each other rather than cause confusion.
• Provide greater technical support to ACO participants to cover the significant startup costs associated with program participation.

“CMS should rapidly adopt policies that will improve participation in MSSP and other existing Innovation Center programs,” the letter continues.

You can read the full letter here.