January 13, 2023
By Travis Broome, MPH, MBA, Senior Vice President, Policy & Economics
We hope you fared as well as can be expected in the frozen east and south to end 2022, or in the soaking west to start 2023. We do not predict that health care policy will be as tumultuous as the weather in 2023.
CMS Policy Changes in Value Will Lead to Growth in MSSP in 2024
Medicare Shared Savings Program growth has been stuck at around 10 million beneficiaries since 2018. While Aledade has been growing year over year, the program itself has been stuck in neutral. COVID, combined with stagnant policy, have kept many practices on the sidelines unless they have a strong partnership. CMS has removed the requirement to move to the highest level of risk and has greatly lowered the headwind for high-cost practices to enter MSSP. These policy changes should generate more fellow travelers in the ACO world in 2024 and future years.
Physician Fee Schedule Payments Technically Set for 2024
When Congress softened the cuts in payments compared to 2022, it also set out a framework for 2024. Early indications are Congress may be interested in revisiting MACRA for a longer-term solution. The urgency will largely depend on whether inflation goes down in 2023 or continues to be high. If inflation continues to tick down, an expensive MACRA fix would be unlikely to make it through a divided Congress.
Telehealth Policy in Formative Stages
Unlike the Physician Fee Schedule, where any change has massive budget implications, telehealth’s impact on spending is more modest and more debatable. Our goal is to ensure continued support of hybrid models supporting the same physician providing in-person and telehealth services for the best long-term primary care relationship. Data will play a large role in this debate, with claims data clearly showing sustained telehealth usage. The telehealth debate will play out both nationally and in each state.
Aledade’s State Policy Efforts Continue to Expand
Aledade’s State Policy program is now up and running in eight states and will be expanding in 2023. In addition to telehealth, we are focused on mandated minimum primary care spend. Minimum primary care spend creates a solid foundation on which to build our ACO efforts. The premise is a sustainable level of investment in primary care with the ACO model rewarding innovation and effectiveness in an outcome-based manner. We will see more interest from states in value-based care than we ever have before in 2023.
Whatever 2023 holds, we are here to support you. Always reach out to us at policy@aledade.com.