In Reaction to Tom Price's Confirmation as HHS Secretary, Industry Stakeholders Tout His Advocacy for Health IT | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

In Reaction to Tom Price's Confirmation as HHS Secretary, Industry Stakeholders Tout His Advocacy for Health IT

February 10, 2017
by Heather Landi
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In an early morning vote, the U.S. Senate voted to approve the nomination of Tom Price as Secretary of the U.S. Department of Health and Human Services (HHS) to serve in the Administration of President Donald Trump.

Price, a Republican Congressman from Georgia and a former orthopedic surgeon, was confirmed in the Senate at 2 am Friday as the nation’s 23rd HHS Secretary in a vote that split along party lines. The vote was 52-47 with all Republicans voting to confirm, and all Democrats, and Independent Senator Bernie Sanders, voting against confirmation. One Democrat, Sen. Claire McCaskill (MO), didn’t vote.

Upon confirmation, Congressman Price resigned his seat as the U.S. Representative for Georgia's 6th Congressional District.

As previously reported by Healthcare Informatics, the party line split on Price’s nomination has made for a contentious nomination process. On Feb. 1, Republicans on the Senate Finance Committee advanced Price’s nomination without committee Democrats present. The move to vote on Price’s nomination with just Republicans present goes against committee rules, which calls for 13 members—including at least one Democrat—to be present for the vote. Republicans voted to suspend the rule that had required at least one Democrat to be present for business to be conducted after Democrats on the committee boycotted the committee vote on Price’s nomination.

In a statement, Senator Lamar Alexander (R-Tenn.), who voted in favor of Price’s confirmation, said, “As the former chairman of the House Budget Committee, Dr. Price has a thorough understanding of health care policy and the damage that Obamacare has caused. He can see the view from the doctor's office as well as from the lawmaker's office and will be an excellent partner as Congress works to rescue Americans trapped in the failing Obamacare system and to build better health care systems.”

Reaction from healthcare industry associations and health IT organizations have been mostly positive and supportive. In a statement, the Healthcare Information and Management Systems Society (HIMSS) stated, “Dr. Price is uniquely aware of the healthcare challenges facing our nation. He has been an advocate for utilizing health IT to improve health outcomes for patients, while decreasing unnecessary burden on providers. HIMSS looks forward to working with Secretary Price to ensure we realize the full value of health IT in ensuring interoperability, improving care, increasing access, and driving better health outcomes to patients. HIMSS also recognizes the potential to explore the broadening of technology’s impact through expanded use of telehealth, increased cybersecurity preparedness, and implementation of 21st Century Cures,” HIMSS officials stated.

HIMSS officials also stated, “During our many engagements with Secretary Price at HIMSS Annual Conferences, our Government Health IT Conference, and as a congressional sponsor for the HIMSS Foundation’s Institute for e-Health Policy, we have found Secretary Price to be an advocate and an ally to those transforming healthcare.”

The Federation of American Hospitals (FAH) wrote of Price becoming HHS Secretary: “His experience as a thoughtful detailed-oriented legislator, combined with his decades working in the medical field make him uniquely qualified to confront the challenges facing patients, families and caregivers. …Further, we look forward to working with Secretary Price to make sure hospitals have the resources to provide essential health services in the communities we serve.”

The Healthcare Leadership Council, a coalition of chief executives from healthcare industry sectors, applauded the Senate vote confirming Price and HLC president Mary R. Grealy said Price’s healthcare and policy expertise will be “an invaluable asset in improving population health, advancing high-quality care for all Americans.” “We view this as a vote for patients and for strengthening our nation’s healthcare system. Dr. Price brings to HHS the healthcare insights of a practicing physician and the policy knowledge he demonstrated as House Budget Committee chairman. These are assets that will enable him to begin work immediately enhancing the quality and accessibility of care for all Americans.”

She added, “Throughout his tenure in Congress, Dr. Price has been a champion for combating the rise in chronic disease, emphasizing wellness and prevention, expanding the use of health data to improve care, and strengthening the Medicare program for future generations of beneficiaries. We look forward to working with him on these priorities in his leadership at HHS,” Grealy stated.

However, there have also been some negative reactions to Price’s confirmation. President of the National Partnership for Women and Families, Debra Ness, described Price as “an extreme opponent of the Affordable Care Act (ACA) and federal funding for women’s health care.” “This vote may cost millions of women and families the access to essential health services they need,” Ness stated. Further, she stated, “Price’s opposition to the ACA, his willingness to cut Medicaid and Medicare, and his relentless opposition to abortion and contraceptive care are deeply disturbing. The ACA has been the greatest advance for women’s health in a generation; it provided coverage to 20 million previously uninsured people and millions with pre-existing conditions who could not get insurance before it became law. Yet Price voted more than 60 times to repeal it. The replacement proposals he supports are wholly inadequate and would leave millions without affordable, comprehensive health coverage.”

Additionally, Carol Paris, M.D., president of Physicians for a National Health Program, a nonprofit research and education organization of more than 20,000 doctors who support single-payer national health insurance, said in a statement that Price’s confirmation as HHS Secretary “is a body blow to the health and welfare of all Americans.”

"Price’s vision for reforming U.S. health care would result in millions of Americans losing their existing health insurance coverage, and millions more having to make do with bare-bones policies that offer little to no meaningful protection. He can also be expected to push high-deductible health plans, which already result in millions of people forgoing needed care, and to undermine Medicare, the Medicaid program and safety-net hospitals,” Paris stated.

As head of HHS, Price will play a large role in President Trump’s future plans regarding healthcare policy, including Trump’s stated plans to repeal and replace the Affordable Care Act (ACA), former President Barack Obama’s landmark legislation. President Trump on Jan. 20 signed an executive order that could open the door for federal agencies to curtail some aspects of the ACA, and in particular, the order aims to reverse "unwarranted economic and regulatory burdens" resulting from the ACA.

Price has been a vocal critic of the ACA, and, according to The Washington Post, the 62-year-old lawmaker, who represents a wealthy suburban Atlanta district, has played a leading role in Republican opposition to the law and has helped draft several comprehensive bills to replace it. “The GOP-led House has voted five dozen times to eliminate all or part of the ACA but has never had a chance to accomplish its goal as long as President Obama has been in the White House,” the Washington Post article stated. Two years ago, Price introduced the Empowering Patients First Act, which called for a full repeal of the ACA.

And, according to The New York Times, as chairman of the House Budget Committee, Price supported “proposals to shift Medicare away from its open-ended commitment to pay for medical services and toward a fixed government contribution for each beneficiary, which could be used for either private insurance or traditional Medicare.”

During two Senate confirming hearings, Senate Democrats sharply questioned Price about his positions on the future of the ACA, the scope of Medicare and Medicaid and the Trump Administration's plan to repeal and replace the ACA.

During the second confirmation hearing, Senator Mark Warner (D-VA) asked Price, “If you’re confirmed in this position, will you use this executive order in any way to try to cut back on implementation or following the individual mandate before there is a replacement plan in place?” Warner continued “One of the reasons so many of us are anxious to see your replacement plan is that the President [Trump] says he wants to have insurance for everybody and he wants to keep the prohibition on pre-existing conditions and keep people on policies until 26 and it seems there is, at the same time, a rush to eliminate all the things that pay for the ability for Americans to have those services. I want assurances that you wouldn’t use this executive order prior to a legal replacement to eliminate the individual mandate, which I would believe helps to shore up the cost coverage and the shifting of cost that is required in an insurance system.”

Price replied, “Any replacement or reform or improvement of the program is imperative to be instituted simultaneously.”

Regarding health IT issues, Secretary Price will need to address a number of issues, including appointments to the Office of the National Coordinator for Health IT (ONC), the future of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Meaningful Use and implementing provisions in 21st Century Cures, which passed into law last year.

21st Century Cures has many health IT-related provisions, including instructing the Secretary of HHS to work with healthcare providers, payers and vendors to reduce regulatory and administrative burdens relating to the use of electronic health records. The bill also authorizes $15 million for ONC’s certification process to improve interoperability and fight information blocking. The legislation would establish a grant program to create an unbiased reporting system to engage stakeholders and gather information about EHR usability, interoperability, and security to help providers better choose EHR products.

Price has previously criticized Meaningful requirements has too restrictive and burdensome and remarked that “Meaningful Use has turned physicians into data entry clerks.”

Price’s nomination had been dogged by questions about his investments in healthcare firms and his trading in health care stocks during his time in Congress. Democrats have criticized Price, saying that he has shown bad judgment by actively trading shares of medical and pharmaceutical companies while shaping health policy in Congress. Among Price’s holdings are some in Innate Immunotherapeutics, Ltd., an Australian biomedical company in which another lawmaker, Rep. Chris Collins (R-N.Y.) is a major shareholder. In the second Senate hearing, Price said, “Everything I did was ethical, above board, legal and transparent, and he reason you know about these things is because we made that information available in real time as required by the House ethics committee.”

 


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NAACOS, AMA, Others Urge CMS to Reconsider MSSP Proposed Changes

September 21, 2018
by Rajiv Leventhal, Managing Editor
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The National Association of ACOs (NAACOS) and eight other healthcare stakeholder groups have sent a letter to the Centers for Medicare & Medicaid Services (CMS), expressing concerns about the federal agency’s proposed changes to the Medicare Shared Savings Program (MSSP).

In August, CMS proposed sweeping changes to the MSSP, by far the largest federal ACO model, with 561 participants. At the center of the proposed rule, called “Pathways to Success,” is a core belief that ACOs (accountable care organizations) ought to move more quickly into two-sided risk payment models so that Medicare isn’t on the hook for money if the ACO outspends its financial benchmarks.

Specifically, CMS is proposing to shorten the glide path for new ACOs to assume financial risk, reducing time in a one-sided risk model from the current six years to two years. This proposal, coupled with CMS’ recommendations to cut potential shared savings in half—from 50 percent to 25 percent for one-sided risk ACOs—will certainly deter new entrants to the MSSP ACO program. So far, the proposed rule has been met with varying degrees of scrutiny.

NAACOS, comprised of more than 360 ACOs across the U.S., is one association that has been actively pushing back on the CMS proposal. The group believes that ACOs need, and deserve, more time in one-sided risk models since it takes years to develop the necessary infrastructure to be successful. What’s more, NAACOS is of the belief that one-sided risk ACOs actually save far more money than CMS gives them credit for.

NAACOS and others—including the American Medical Association (AMA), Medical Group Management Association (MGMA), and Premier—said in a press release accompanying the letter to CMS that the proposed Pathways to Success program would create several positive changes and includes a number of improvements the value-based community has previously recommended.

However, the groups also explained their concerns about CMS’ proposals to reduce the time new ACOs have in shared savings-only models from six to two years and to decrease the shared savings rate from 50 percent to 25 percent. The letter urges CMS to instead allow more time for ACOs in a shared-savings only model and to apply a shared savings rate of at least the current 50 percent to ensure a viable business model.

The groups wrote, “The MSSP remains a voluntary program, and it’s essential to have the right balance of risk and reward to continue program growth and success. Program changes that deter new entrants would shut off a pipeline of beginner ACOs that should be encouraged to embark on the journey to value, which is a long-standing bipartisan goal of the Administration and Congress and important aspect of the Quality Payment Program.”

It remains to be seen how CMS will respond to the pushback from NAACOS and others of late, though up to this point CMS has taken a firm stance that upside risk-only ACOs have not been effective. Thus, the federal agency seems to be fine with these ACOs leaving the MSSP if they are unwilling to take on more risk.

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Check and Checkmate: Is the Debate Around the MSSP ACO Program About to Get Super-Heated?

September 12, 2018
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Will NAACOS’s just-published study turn the tables on senior CMS officials? Or will it be ignored?

Something really quite extraordinary happened this week: NAACOS, the Washington, D.C.-based National Association of Accountable Care Organizations, published, in the august journal Health Affairs, a study based on research that NAACOS leaders had commissioned from Dobson DaVanzo & Associates, a healthcare economics consulting firm. And, as Healthcare Informatics Managing Editor Rajiv Leventhal noted in his report, “Medicare’s largest ACO (accountable care organization) initiative—the Medicare Shared Savings Program (MSSP)—generated gross savings of $1.84 billion for Medicare from 2013 to 2015, nearly double the $954 million estimated by the Centers for Medicare and Medicaid Services (CMS),” according to the NAACOS/Dobson DaVanzo & Associates study.

And here’s what’s extraordinary about that: this is the first time in my memory that I’ve seen a national association of provider organizations commission independent research that directly contradicted federal government findings and statistics. Could this be the start of a major conflict over the direction of the MSSP program? The potential for actual conflict here is quite real. But first, let’s look at what NAACOS and Dobson DaVanzo found. As Leventhal noted, “The study, which used similar scientific methods as a 2018 peer-reviewed paper by Harvard researchers published in The New England Journal of Medicine, found that MSSP ACOs reduced Medicare spending by $541.7 million during the 2013 to 2015 timeframe, after accounting for shared-savings payments earned by ACOs.”

The MSSP is the largest value-based payment model in the U.S., growing to 561 ACOs with more than 350,000 providers caring for 10.5 million Medicare beneficiaries in 2018. Under current MSSP rules, new ACOs are eligible to share savings with Medicare for up to six years if they meet quality and spending goals but are not at financial risk for any losses. As such, CMS has been reiterating in recent months that these “upside risk-only” ACOs are costing the government money.

What’s more, as Leventhal noted, “To this point, in a recent proposed rule that has so far been met with varying degrees of scrutiny, CMS is proposing to shorten that glide path for new ACOs to assume financial risk, reducing time in a one-sided risk model from the current six years to two years. This proposal, coupled with CMS’ recommendations to cut potential shared savings in half—from 50 percent to 25 percent for one-sided risk ACOs—will certainly deter new entrants to the MSSP ACO program. Importantly, CMS has essentially said they don’t mind if upside-only ACOs that are costing the government money leave the program if they aren’t willing to take on more financial risk. CMS Administration Seema Verma said in a press call following the proposed rule’s release that ‘[Upside-only] ACOs have no incentive, at all, to reduce healthcare costs while improving outcomes, as they were intended.’ Nonetheless, MSSP ACO participants seemingly performed quite well in 2017, despite CMS’ claims that they have been largely ineffective. In sum, the 472 ACOs that were in this model last year achieved $314 million in net savings to Medicare in 2017 after accounting for bonuses paid from the government, and $1.1 billion overall.”

For the NAACOS leaders, the key element here is that, as the authors of the Health Affairs article pointed out, “Despite the positive 2017 results, gauging MSSP performance based on calculations using administratively derived spending targets (benchmarks) is simply not an accurate way to measure overall program savings. In fact, the published academic research on MSSP performance points to much higher savings than are suggested by the benchmarks.”

Explained further by the researchers, for its analysis of Medicare ACOs, “CMS calculates an initial risk-adjusted spending benchmark for each ACO based on its historical spending for a group of attributed Medicare beneficiaries; it then trends this benchmark forward to the current program year based on the national average growth in Medicare spending per beneficiary.” The article’s authors further point out that if an ACO’s spending is less than the benchmark, and has a savings rate of at least 2 percent—and the ACO meets MSSP quality thresholds—it earns a shared savings payment that is typically 50 percent of the calculated savings. CMS then calculates total MSSP savings as the sum of total savings for ACOs with spending below the benchmark, plus the sum of spending above the benchmark for ACOs that exceeded it. Using this method, CMS estimated MSSP savings of $954 million between 2013 and 2015. During this period, ACOs that saved money earned $1.3 billion in shared savings payments. CMS concluded that on a net basis, the program increased Medicare spending by $344 million between 2013 and 2015, according to the NAACOS analysis and Health Affairs commentary.

At this juncture, there is an obvious issue here, because CMS’s calculation method implicitly makes it difficult for ACOs to show progress, since savings are benchmarked against administratively derived targets, rather than actual savings. Who came up with that method, anyway???

And the implications of using such a method are clear. As the press release that NAACOS issued upon the publication of the Health Affairs article noted, “Despite the growing ACO track record of improving quality and saving Medicare money, CMS, in an August 17 proposed rule, moved to shorten the time new ACOs can remain in the shared-savings-only model from the current six years to two years. Data show ACOs need more than two years to begin showing the benefits of forming an ACO. That proposal, coupled with CMS’s move to cut shared savings in half — from 50 percent to 25 percent for shared-savings-only ACOs — would deter new Medicare ACOs from forming.”

What’s more, the press release quoted Stephen Nuckolls, CEO of Coastal Carolina Quality Care in New Bern, N.C., which includes 63 providers caring for 11,000 Medicare beneficiaries, as stating that “It takes time and money to transform entrenched care delivery practices in local communities and build the critical mass to successfully integrate care, manage risk, and improve quality while reducing spending growth. Unfortunately, the proposed changes will hold up the move to value-based care by significantly undermining the business case to voluntarily form new Medicare ACOs.” 

I take Mr. Nuckolls’s charge very seriously. I interviewed him recently, and as he noted in our interview, when asked the secret of his ACO’s success so far in the six-plus years in which Coastal Carolina Quality Care has participated in the MSSP program, “[I]t takes time for some of these strategies, such as population health, to pay off. Another thing that’s going on is that our care management program, I give credit for keeping our costs low and getting things in place. And in addition,” he told me, “we really made a lot of strides in our first contract cycle, specific to our market. All of our annual wellness visits and preventive care, we made our marks there and that positioned us well in our second contract cycle. And it just takes time, when you focus on the quality of care, for… when a greater percentage of your patients have their blood pressure under control, you’ll have fewer adverse events. And when you work to lower a1cs, that will avert events over time. And annual wellness visits, vaccinations, screening services—it costs money for screenings; and once you get things set up, that’s then in place. And care management services—when you go into your second contract cycle, you have some of those costs worked into your contract cycle the second time; so it takes time to achieve shared savings, and to get the staff to focus on the sickest population.”

What’s more, what Nuckolls told me in our interview reflects what virtually every ACO leader I and my colleagues at Healthcare Informatics have heard from ACO senior executives—that it takes several years to lay the foundations for ACO success.

What’s more, Nuckolls told me, the results revealed in this data review-based study and article are important, as they speak to “the policy point—organizations are truly saving the government money, even if it doesn’t immediately show on paper. The evidence doesn’t support the idea that ACOs should be kicked out because they have a bad benchmark. The true savings to the Medicare Trust Fund will then be less. And that’s what they need to focus on, achieving true savings to the government.”

So, the obvious question now is, what will happen next? Will CMS Administrator Seema Verma lash out against NAACOS, denouncing this “rival” analysis of MSSP ACO savings? Will she ignore it? Or will she reach out to NAACOS’s leaders, and attempt to find common ground, as the “Pathways For Success” program potentially threatens the expansion of the voluntary MSSP program? It feels as though a lot is hanging in the balance right now, because if the national association representing ACOs has just come out with what is implicitly a denunciation of CMS’s method for calculating ACO progress and success, that is a fairly major “j’accuse” that Administrator Verma and her fellow senior CMS and HHS officials would do well to consider carefully. So the next move on this chessboard is Ms. Verma’s. And who knows what that move might look like?

 

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Seema Verma’s Big Picture: Tough Love, ACO Acceleration, Interoperability, and Consumer Empowerment?

August 29, 2018
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Will CMS Administrator Seema Verma’s strategy of pushing hard on providers around ACO development and interoperability help to accelerate the shift to value-based healthcare—or will it backfire?

Whatever may come, CMS Administrator Seema Verma is standing steadfast in her “tough-love” stances towards providers when it comes to ACO development. As Healthcare Informatics Associate Editor Heather Landi wrote on Monday, “During a webinar sponsored by the Accountable Care Learning Collaborative Monday morning, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma reiterated the agency’s focus on pushing healthcare providers in accountable care organizations (ACOs) to take on two-sided risk while also addressing CMS’s commitment to try to remove barriers to value-based care.”

Further, Landi wrote, “During the 30-minute webinar sponsored by ACLC, a Salt Lake City-based accountable care collaborative, Verma discussed the sweeping changes that CMS is proposing for the Medicare Shared Savings Program (MSSP), noting that ‘it is time to take the next step.’ On August 9, CMS proposed a rule that included major changes to the existing MSSP ACO program, with the goal to push ACO organizations into two-sided risk models by shortening the duration of one-sided risk model contracts. Referred to as “Pathways to Success,” CMS’ proposal looks to redesign the program’s participation options by removing the traditional three tracks in the MSSP model and replacing them with two tracks that eligible ACOs would enter into for an agreement period of no less than five years: the BASIC track and the ENHANCED track. Verma’s comments on Monday morning emphasized CMS’s firm stance on pushing healthcare providers to take on more risk, as well as CMS’s strategy of giving providers more flexibility—such as waivers around telehealth—as a reward to transitioning to value-based care.”

What’s more, Administrator Verma came to the webinar with data. As Landi reported yesterday, “For the 2016 performance year, the Next Gen ACO Model generated net savings to Medicare of approximately $62 million while maintaining quality of care for beneficiaries, according to CMS. Overall, that represents a net reduction of 1.1 percent in Medicare spending within that program, Verma said. The Next Gen ACO model began in January 2016 with an initial cohort of 18 participants. It should be noted that 15 out of the 18 NGACOs had prior Medicare ACO experience.

Verma was not shy about what she thought those metrics meant. “What this really shows is that these Next Gen ACOs are taking the highest levels of risk and they’ve managed to maintain quality while still lowering cost,” Verma said during the webinar. “Much of the savings achieved by the Next Gen ACOs were largely due to reductions in hospital spending and spending in skilled nursing facilities, and that’s very consistent with what we’ve seen with how other two-sided ACOs have achieved savings. We’re excited about this; we think it’s a very strong start.”

Good cop, bad cop?

I’m impossible not to contrast Verma’s statements about the Next Gen ACO program with how CMS characterized the proposal it released just three weeks ago, on August 9. On that date, as Managing Editor Rajiv Leventhal and Associate Editor Heather Landi reported, “The Centers for Medicare & Medicaid Services (CMS) is proposing a new direction for ACOs (accountable care organizations) in the Medicare Shared Savings Program (MSSP), with the goal to push these organizations into two-sided risk models.”

Further, they wrote, “Referred to as ‘Pathways to Success,’ CMS’ proposal, which has been expected for a few months, looks to redesign the program’s participation options by removing the traditional three tracks in the MSSP model and replacing them with two tracks that eligible ACOs would enter into for an agreement period of no less than five years: the BASIC track, which would allow eligible ACOs to begin under a one-sided model and incrementally phase-in higher levels of risk; and the ENHANCED track, which is based on the program’s existing Track 3, providing additional tools and flexibility for ACOs that take on the highest level of risk and potential rewards. At the highest level, BASIC ACOs would qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program.”

And, Seema Verma has made numerous comments now in numerous speeches to numerous different healthcare groups, making it very clear that she is becoming impatient with the pace of change in U.S. healthcare, and is determined to do something about it—with the support of Health and Human Services Secretary Alex Azar, her boss.

Indeed, Verma’s first in a series of speeches around interrelated topics of value-based payment and care delivery, patient/consumer empowerment, interoperability, and technology advancement, came as early as the HIMSS Conference in Las Vegas, where, on March 6, she “spoke of the need to move forward to empower patients with their data and information, in remarkably personal terms, recounting an episode in which her husband had collapsed while the two of them were not together, and was rushed to an emergency department, for what turned out to be heart failure,” as I reported at the time.  In the wake of her husband’s health crisis, she experienced the difficulty of accessing her husband’s health record, as an authorized family member. And that experience, she said, particularly animated the development of the MyHealthEData initiative she was unveiling on that date.

“The reality,” Verma said, “is that once the information is freely flowing from patient to provider, the advances in coordinated, value-based care, will be greater than anything we could imagine today she said back in March. Things could have been different for my family if my husband could have authorized me to have his health records on his phone,” she said. “Or if he could have notified me that he was in distress. And better yet, maybe we could have predicted his cardiac arrest days before, if his watch could have tracked his health data, and sending that data to alert his doctor, and possibly prevent what happened. My husband is part of the 1 percent that survives his condition. We shouldn’t have to depend on chance” for that type of outcome, she emphasized.

The big picture: pushing on several levels at once?

It seems clear that Azar and Verma—certainly, with the help of Donald Rucker, M.D., National Coordinator for Health IT—are determined to acceleration the transition of U.S. healthcare providers into value-based healthcare, through a combination of different incentives, including a wide variety of carrots and sticks. And, not to mix too many metaphors here, but it also seems clear that her praise of the progress made by the Next Gen ACO program ACOs is evidently a “good cop” positioning, while she largely framed the relatively modest progress in the MSSP program in a “bad cop” sort of way, essentially telling MSSP ACO leaders that it was time to stop with upside-only risk, and move into two-sided risk as quickly as possible.

Of course, the risks in this kind of approach are significant. Not surprisingly, the National Association of ACOs (NAACOs) heaped scorn on the August 9 “Pathways to Success” proposal, with NAACOS CEO Clif Gaus saying in a statement released that evening, that “The administration’s proposed changes to the ACO program will halt transformation to a higher quality, more affordable, patient-centered healthcare industry, stunting efforts to improve and coordinate care for millions of Medicare beneficiaries.” According to Gaus, “The downside financial risk for patient care would be on top of the significant financial investments ACOs already make, jeopardizing years of effort and investment to improve care coordination and slow cost growth.” He continued, “CMS discusses creating stability for ACOs by moving to five-year agreements, but they are pulling the rug out from ACOs by redoing the program in a short timeframe with untested and troubling polices.”

So it seems to me that Azar, Verma, and Rucker, and their colleagues, are in a bit of a challenging place here, because even as the progress has been measurably stronger in the Next Gen ACO program compared with that in the MSSP program, even in Next Gen, it hasn’t been spectacular. Meanwhile, Verma’s attempts to push down harder on the levers of payment and regulation in order to turbocharge ACOs, could very easily backfire, causing more ACOs to leave the MSSP program than to switch to two-sided risk.

So this is a delicate, complicated moment. Will “tough love” and “good cop, bad cop” strategies at HHS and CMS really work? Only time will tell—but this feels like an important moment in the evolution of value-based healthcare, with no clear answers as to how HHS (the Department of Health and Human Services) and CMS officials might be successful in forcing transformational change forward, at a time when the coming U.S. healthcare cost cliff is looming more closely than ever before, just up a head. As Bette Davis said, as Margo Channing, in Joseph L. Mankiewiecz’s 1950 film “All About Eve,” “Fasten your seat belts—it’s going to be a bumpy night!”

 

 

 

 

 

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