- Medicare Advantage and accountable care organizations could be vehicles for much needed value-based payment reform in Medicare, but not without better aligned incentives and improved quality assessment, according to the Medicare Payment Advisory Commission's June report to Congress released Monday.
- For ACOs in the Medicare Shared Savings Program, the commission suggests HHS use national provider identifiers instead of taxpayer identification numbers. Using TINs could grant some ACOs unwarranted shared savings through favorable patient selection, MedPAC concluded.
- In its separate June report to Congress, the Medicaid and Children's Health Insurance Program Payment and Access Commission suggests lawmakers create a special enrollment period for people dually eligible for Medicaid and Medicare and allocate more funds for states to implement integrated care models for those beneficiaries, who it notes are particularly vulnerable to severe illness from COVID-19.
Both reports to Congress acknowledge that the COVID-19 pandemic is engulfing healthcare in the United States, but the work presented has been ongoing since before the novel coronavirus hit the country.
"The health care system and, most importantly, the individuals caring for the victims of the pandemic need our support and the resources to do their jobs," the MedPAC authors wrote. "We will provide whatever advice and assistance that we can at this time to Congress and CMS as the Medicare program adapts to today's realities."
The authors also commented, however, that the pandemic "has demonstrated that the system is capable of rapid change when circumstances require it to do so."
The National Association of ACOs said it supported MedPAC's recommendations. "NAACOS wholeheartedly agrees with MedPAC that we need to accelerate the transition to value and encourage more providers to participate in 'accountable entities,'" the group wrote.
The report suggests Medicare could do more to encourage global or capitated payments in Medicare Advantage plans, which would provide more predictable revenue. That would be especially helpful during upheaval like from the COVID-19 pandemic, the authors wrote.
In a call with reporters Monday morning, MedPAC Executive Director Jim Matthews said not enough payments are tied to value in the program currently. "The commission has determined that progress toward value-based payment throughout the Medicare program needs to accelerate and more of the program needs to be detached from straight fee-for-service payment," he said.
The advisory panels reports to Congress are nonbinding, but offer commentary lawmakers and other policymakers use to evaluate changes to the massive government health programs.