Premier Inc. Leader Explores APM Landscape in a Moment of Change

Where is the population health care/value-based health care train headed? I’m here. healthcare innovation Editor-in-Chief Mark Hagland recently spoke with Melissa Medeiros and Seth Edwards of Charlotte-based Premier Inc. about the various problems, challenges and opportunities in these areas. Medeiros is Premier’s Senior Director of Policy, Government Relations and Edwards is Vice President of Population Health and Values-Based Care. Below are excerpts from their extensive interviews.

Melissa, what areas does Premier’s policy area cover?

Melissa Medeiros: I oversee value-based care, quality interventions, and everything related to Medicare.

And what is your biggest concern right now?

One of our top priorities is around advanced incentive payments that expire at the end of the year, so we are pushing to extend these policies.Macra [the Medicare Access and CHIP Reauthorization Act of 2015] 5% bonus included for clinicians working on advanced APM [advanced payment models]And as of 2022, these bonus payouts have a two-year delay between the payout year and the performance year. There is considerable concern about people moving to advanced APM, or those already involved, losing their incentive to keep moving forward.

Which APM is involved?

MSSPs [Medicare Shared Savings Program] is the largest, but only certain practices qualify. Providers participating in the ACO REACH model and participating in bundled payments are also eligible. Targets a specific track. Bonuses are for doctors and other clinicians.

Is that your main policy focus now?

This is one of our main areas of focus right now. Held a joint hill briefing with APG [America’s Physician Groups] and NAACOS [the National Association of ACOs], last week. We partner very closely with them. And that briefing expanded on some of the specific APMs and focused broadly on value-based care.

Seth, what are you most involved in right now?

Seth Edwards: A large part of the work we’ve done is helping organizations develop population health strategies, an environment in which organizations are seeing significant cost increases in terms of supply costs and workforce. and to do it within a paradigm. What is the best way for hospitals or ACOs to move forward? If only one of the most costly heart failure readmissions could be avoided (in fact, most readmissions are actually low-margin or non-contributing events). ), you can really help these organizations. So streamline your delivery model to make sure you’re not only doing what’s best for your organization and community, but for the long-term health of the health system as a whole. is under consideration.

Can you talk about the fact that this may be a particularly difficult time for provider organizations that have hitherto stuck with fee-based contracts to jump into value-based contracts? , which has caused hospitals and the healthcare system great financial pain, especially in terms of revenue, has a much narrower profit margin than it did two and a half years ago.

I actually think this is the perfect time to take advantage of what they hope will be finalized in their remuneration schedules. The margins they face under Medicare And it’s a good time to look at the challenges of and move on. How long will that negative margin last, and how long will labor costs continue to rise? If you can enter your MSSP and share your savings, you can earn new margins. It is therefore an opportune time for organizations that have traditionally focused on hospital-based care to move toward a truly integrated healthcare delivery system. We call it future proofing. I don’t think medical care will cost more. And as prices continue to be forced down and reimbursement pushed down, now is the time to work on new ways to support the delivery of value-based care.

Medeiros: We have confirmed that CMS has issued a policy aimed at bringing new providers into its value-based program. The administration now focuses a lot on providing new flexibility. We also saw new opportunities for advanced investment payments for smaller providers lacking experience in value-based care. Hopefully, some of these policies will be finalized early next month, and we’ll be finalizing our doctor’s fee schedule.

Edwards: And as we pursue the goals outlined in the 2030 vision paper released by CMMI, organizations need to move forward if everyone is to become an accountable model for Medicare by 2030. I have. Because if you don’t move into an accountable relationship with Medicare, it will be commoditized compared to other organizations.

Where do members struggle the most?

Edwards: We work with about 70 organizations in the collective health community. Some groups are just getting started. Some say he has been working in this field for 20 years. But a common requirement for all of them is being able to help develop a strategic roadmap or risk maturity model. Does this help you conceptualize how quickly your organization needs to transition to risk for each payer sector: Medicare, Medicare Advantage, Commercial Insurance, Medicaid, and Direct Employer Contracts. So when you look at each of these payer segments, how quickly do they move to risk, what are the capabilities needed to succeed at each step, how are market systems prepared and how do payers move? You have to decide what to take into account. Preparing to implement a maturity model. That means developing that strategy and planning it thoroughly. Requires a lot of care management support. Infrastructure for managing population. This includes technology and analytics. We do a lot of work to not only help organizations make sense of their data, but to develop a complete and accurate documentation and coding strategy.

How will things evolve in the next five years?

How will things evolve over the next five years? Depending on the outcome, physician fee schedules, and how the Medicare Advantage market adapts to emerge from the public health emergency, several groups There will be some. It may affect future MA payments. Some members may transition to high risk. In general, the more risk you take, the more upside opportunities you have.they will believe there is an opportunity

Providers say they’re learning from Medicare Advantage and it’s helping them take double-sided risks with Medicare.

Yes, many of our members have learned that, but many organizations are involved in health insurance risks through joint ventures, partnerships, or contractual elements involving shared savings. So I think that’s the trend we’re seeing and the group trying to take more risks and solidify the pressure on profits. There are groups that have acquired medical integration and are moving towards bilateral risk. But I believe it is very likely to double as it can be commercialized.

One of the points of tension between CMS [the Centers for Medicare & Medicaid Services] The previous administration’s providers also exceeded the benchmarks of the MSSP program. This was something the provider found too difficult, for example he felt that the detail felt by the NAACOS leader would result in many provider organizations leaving his MSSP. Seema Verma was advocating for providers to take on the two-sided risk sooner than many would like.

Medeieros: We were all surprised by what CMS offered last year. There has definitely been a shift in thinking between administrations. There seems to be less focus on progressing to risk, as has happened on the road to success. There seems to be a recognized concern that if ACOs continue to participate in the program, there may be a race to the bottom, competing with previous successes, per benchmark. We have provided feedback on it. They are trying to set a set of management standards for five years. We encouraged them to work with stakeholders. I love his RFI from this administration. I’m sure they’re listening, and this past doctor’s compensation schedule has shown some flexibility.

According to it, the proposed rule was announced in July. The final rule, he expects, will be repealed around November 1st and take effect in calendar year 2024. So early next month should give you a better sense of where things are going. But I think some requirements could be implemented gradually. Also factoring in previous savings, it’s a policy people have been asking for for some time. Reach MSSP Sustainability. There has certainly been a shift from administration to administration.

Edwards: I agree. Change is happening. Also, the emphasis seems to be on getting more organizations on board rather than quickly putting them at risk. This will not only increase the number of organizations interested in participating, it will only maintain current participation.

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