Two recent developments signify a growing emphasis on value-based care in the U.S. health care system: establishment of a new flexibility within the Quality Payment Program (QPP) and creation of the Health Care Innovation Caucus.
Beginning in performance year 2019, the “All-Payer Combination Option” will be added to QPP to give clinicians more opportunities to participate in an Advanced Alternative Payment Model (APM). There are two tracks within the QPP established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): participation in the Merit-based Incentive Payment System (MIPS) or an Advanced APM.
The APM track is open to relatively few providers because 1) clinicians must participate in a Medicare Advanced APM and 2) they must satisfy a sufficient volume requirement. The All-Payer Combination Option will allow more clinicians to join the APM track because under the new system, clinicians can either participate in just Medicare Advanced APMs OR a combination of Medicare Advanced APMs and other payer advanced APMs to meet the volume requirement. CMS plans to allow both payers and clinicians to initiate a determination on whether a non-Medicare model qualifies as an advanced APM. However, only providers and their respective APM entities will be able to initiate a determination for the 2019 performance period. The window in which requests may be submitted will be open in late 2019.
Another way in which efforts to implement value-based care are being accelerated is through the creation of the Health Care Innovation Caucus. The purpose of the bipartisan group is to promote federal policies that will shift the U.S. health care system toward value-based payment models. The caucus is led by representatives Ami Bera (D-Calif.), Mike Kelly (R-Pa.), Ron Kind (D-Wis.), and Markwayne Mullin (R-Okla.).
Many stakeholders have expressed support for the new caucus. According to Jeff Micklos, executive director of the Health Care Transformation Task Force, “The caucus will bring much needed leadership on the issues facing the U.S. health care system.”
For more information on the Quality Payment Program and value-based care, visit the AASM MACRA page.