Policy Update: Evaluating Value-Based Health Care Models
August 2, 2021

The cicada brood X has started to emerge in DC. The noise hasn’t started yet, but they are
everywhere now. Travis’s kids were not particularly pleased to discover that cicadas are a tasty
treat for birds, but the birds don’t always eat the whole bug.

Evaluating Value-Based Health Care Models

On April 29th we introduced an Aledade framework for how to evaluate models. Over 130 people
attended the webinar, a recording of which is here. A quick overview of that framework follows:

We categorize models as heavily weighted to either being a financial model or enabling model.
ACOs, for example, are financial models. Most models have both features.

Characteristics of a Financial Model:

  • Amounts are determined by outcomes and outcome-based formulas, not based on the cost of providing services.
  • Few compliance requirements
  •  No restrictions on what the payments can be used for
  • Creates a return on investment for new work, but not direct funding

Characteristics of an Enabling Model:

  • Funding directly aimed at a specific service; and/or
  • A regulation that allows or requires a specific service to be delivered
  • Large compliance obligations
  • Payments are restricted in their use
  • Can create an immediate return on providing the specified services

We walk through Direct Contracting (50/50 Financial and Enabling) and PCF (90 percent
Enabling) in the webinar. As models continue to proliferate, we will use this framework to
describe them.

Upcoming Deadline for Primary Care First

Primary Care First applications are due May 21, 2021. If you are in an affected region and still
need more information about what PCF means for you, please reach out to us or your Executive
Director ASAP. This application is non-binding and practices will have until later in the year to
decide whether they want to sign the participation agreement for the program.

PCF Participating Regions

For more information on PCF participating regions and payer partners, see here.

Advanced Alternative Payment Bonus

If you were in an Enhanced MSSP ACO or a Level E MSSP ACO in 2019, even if it was just for
July – December of 2019, you are eligible for the AAPM bonus. The calculation for this bonus is
the revenue you received under Part B (excluding drugs) for 2020 times 5%. This lump sum will
likely be paid in August or September 2021. Your Executive Director will be reaching out with
more information in the coming days.

In CMS News the New Administrator is Held Up in the Senate

Sometimes nominations get held up for reasons other than the qualifications of the nominee.
This is happening right now to Chiquita Brooks-LaSure, whose nomination is on hold due to the
Biden Administration revocation of a Medicaid waiver in Texas. Practically speaking this means
the 2022 physician fee schedule is being written without her, which likely means any big moves
by the new Administration will come in 2023 instead of 2022.