HHS Secretary Alex Azar on Tuesday hinted at further pushes from CMS on value-based care, including population health benefits like those newly allowed in Medicare Advantage and per-member per-month payments for a patient's total cost of care.
Speaking at the Milken Institute Future of Health Summit in Washington, Azar gave the example of paying a provider $14,000 a year for all of a person's health costs — regardless of how much care is actually required.
"If [a provider] can help that patient — not through gate keeping, not through rationing — but through coaching, advising and guiding," they can reap profit, he said.
CMS has developed a primary care program pushing more downside risk on providers, but last week said the start of the model would be pushed back a year. One path on that program includes a flat monthly fee for some patients with chronic illnesses. The first participants in the five-year model will now start January 2021.
The agency also said last week organizations already in the Medicare Shared Savings Program would be allowed to participate in the new model, news cheered by ACOs.
Azar also touted CMS models on kidney care and opioid misuse and promoted non-medical benefits that can help patients with social determinants of health. Several insurers ramped up those benefit types for their 2020 Medicare Advantage plans, including offering pest control services and transportation assistance to grocery stores.
"They might say 'you know what I can keep this senior out of the nursing home and mobile, independent, out of the hospital, by investing and getting her an air conditioner, get her meals delivered, maybe have a home health aide check in occasionally,' " Azar said.
He also defended the Trump administration's handling of the Affordable Care Act, deriding the law as "fundamentally broken."
Still, he added that "while we have this program we're going to run it as best we can for the American people."
A ruling that could overturn the landmark law is expected any day now from the Fifth Circuit Court of Appeals. In December, a Texas judge ruled the ACA did not pass constitutional muster without its individual mandate penalty. The case is almost certain to eventually end up before the U.S. Supreme Court, possibly while the 2020 presidential election is in full swing.
Azar did not discuss the pending court case and was not asked about it. Last week, CMS Administrator Seema Verma ducked lawmakers' questions on whether the administration has a backup plan if the law is struck down.