Living in a MACRA world: How one law will change care delivery - - PowerPoint PPT Presentation

Living in a MACRA world: How one law will change care delivery

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Agenda

• ACLC updates
• Introduction of guest presenters
• Presentation by Clay Alspach, Leavitt Partners
• Presentation by Dr. Mark McClellan, Duke University
• Opportunity for Q&A

Members can submit questions ahead of time by using the question box of the Zoom window

Upcoming member event(s)

ACLC Member Meeting at HIMSS17 Orlando, FL

February 20th

• Co-located with the HIMSS17 Annual Conference
• Members of the ACLC are invited to attend a second Healthcare Conference day on Tuesday, February

21st hosted by Leavitt Partners

Look for registration links in weekly news every Tuesday

Guest Presenter

Clay Alspach

Principal Leavitt Partners

Post-Election, New Administration Insights

Top 10 He Health lth Poli licy cy Ac Actio ions ns to Watch h

1 2 3 4 5 6 7 8 9

1

Substantial health care legislation in 2017 - ACA repeal/replace, CHIP and FDA user fee reauthorizations Key appointments will reflect planning done by transition team (Price, Verma) Use of reconciliation to repeal some ACA components where possible – H.R. 3762 is base Some ACA areas are too embedded in law and the health care system to repeal Private sector pushback on other ACA components where change is underway Republican governors who expanded Medicaid will push back on repeal Look to the June report from the House Republican Health Care Reform Task Force and Price’s health reform bill for policies that will be top priorities in replace Private sector collaboration is critical to continue to address quality, value based care and coverage MACRA will sustain; 2017 performance period will provide key data/feedback for policymakers GOP disagreement on how far to push on Medicare reform

7

• Jan. 2017
• Feb. 2017

March 2017 April 2017 May 2017 June 2017 July 2017 August 2017 September 2017

• Oct. – Dec. 2017

Reconcili liat ation ion for Possib ible le ACA and Entit itlem lemen ent Refo forms (Repeal and Replace, Side-car for Medicare and Medicaid reform, CHIP reauthorization, Medicare, Medicaid Public Health extenders) (Jan-July)

2017 Co Congressio essional al Ag Agenda

Expiring Policies Congressional Agenda

Inaug augur urat ation ion (Jan. 20) Suprem eme Cour urt and Cabine inet Nominat ination ions (Jan-Feb.) FY18 Appropria iation ions Bills (April-Sept.) FY18 POTUS Bud udget (March) FY18 Cong ngres ession ional l Bud udget and Recon

• ncili

liat ation ion Instructions (April) UFAs (March-Sept.)

CHIP Expires Sept.

Medic icare are, Medic icai aid, Pub ublic ic Heal alth h Exten enders Expire Sept. or Dec.

UFA Pink slips sent (July) FY 17 Approps Expire Sept.

UFAs Expire Sept.

Debt Cei eili ling Reach ached ed (summer)

8

Tax Reconcili liat ation ion Veh ehic icle le (April-July)

Key: President House & Senate House Senate

2016

Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

President Submits FY2017 Budget

2/8/2016

House Budget Committee Approves FY 2017 Budget (House C.R. 125 filed on March 23)

3/16/2016

No Further Action Expected

12/31/2016

2016 Key Events (Reconciliation Process)

9

Repeal and Replace

2017

Key: President House & Senate House Senate

Jan Feb Mar Apr May

House E&C, W&M and Committees submit legislative text of Obamacare repeal/replace reconciliation bill to House Budget Committee

1/25/2017

House Budget Committee approves Obamacare Repeal/Replace reconciliation bill

1/31/2017

House approves Obamacare Repeal/Replace reconciliation bill; Sends to Senate

2/3/2017

Consideration by Senate of Fiscal Year 2017 Budget

1/13/2017

Statutory Deadline for President Trump’s Fiscal Year 2018 Budget

2/6/2017

President Trump submits Fiscal Year 2018 Budget

4/10/2017

House and Senate approve modified Repeal/Replace reconciliation bill (potential sidecar for non-reconciliable issues); Sends to President Trump

3/10/2017

President Trump signs Repeal/Replace reconciliation bill

3/17/2017

100th Day in Office

Mid-May

First Repeal & Replace Reconciliation

10

Repeal and Replace

House considers approves FY 2017 Budget Report sent by Senate

1/9/2017

2017

Key: President House & Senate House Senate

May Jun Jul Aug

House W&M submits legislative text of tax provisions (including possibly Obamacare taxes) to House Budget Committee (2)

Jun

House Budget Committee approves reconciliation tax bill (3)

Jun/Jul

House approves reconciliation tax bill; Sends to Senate

Jul

House approves modified reconciliation tax bill; Sends to President Trump

Aug

President Trump signs reconciliation bill

Aug

House and Senate approve Fiscal Year 2018 Budget Conference Report; 2nd reconciliation process begins. (1)

Jun

House and Senate Budget Committees approve FY2018 Budgets

May

House and Senate Approve Fiscal Year 2018 Budgets

May

Senate Finance Committee approves reconciliation bill

Jul

Senate approves modified reconciliation tax bill; Goes back to House

Jul

Second Tax Reconciliation

11

Repeal and Replace

Target

Value-Based Payment Statutory curtailing of CMMI authority* (e.g. expansion authority, mandatory demos, future funding; does not mean elimination) MACRA delay or hindrance Medicaid Block grants* Medicaid 1115 waiver flexibility* End Medicaid Expansion* FMAP changes* Medicare Medicare Provider Cuts Age 55 “Medicare for All” IPAB repeal* Health IT EHR flexibility, promotion of interoperability, anti-blocking Telehealth (e.g. CONNECT for Health)

12

*=Eligible and possible for Reconciliation

Election Outcome Impact

Target

Tax Issues Cadillac Tax Repeal* Medical Device Tax Repeal* Health Insurance Tax Repeal* Insurance Markets Repeal Individual Mandate* Repeal Employer Mandate* Public Option ACA Marketplace changes (privatize healthcare.gov, state control of state exchanges) Selling products across state lines Insurance regulation reforms (essential health benefits, 3:1 age-banding, guaranteed issue, lifetime limits, repeal or modify consumer subsidies (CSR and APTCs), metal tiers, MLR, RA) 1332 waiver flexibility FDA Drug Pricing--Transparency Drug Pricing – Price Controls Drug Pricing (e.g. importation) FDA Reform UFAs

13

*=Eligible and possible for Reconciliation

Election Outcome Impact

MACRA

Key Developments Post-Election Likelihood of Action

• ACA related initiatives such as the individual mandate, independent

payment advisory board, and various taxes are higher priorities for change

• Rep. Tom Price (R-GA), who has been nominated as HHS Secretary,

will be a key player to watch on MACRA. He had concerns regarding the proposed rule, but the changes in final rule moved in his direction.

• Rep. Michael Burgess (R-TX), who is the author of MACRA, was just

named as Chair of the Health Subcommittee of the House Energy Commerce Committee. He also will be a key player to watch. Administration

• Trump’s election not likely to impact MACRA’s roll out given its

passage received 90% Senate support.

• 2017 performance period will provide key data/feedback. Price

and CMS will watch closely.

• If Congress or new HHS secretary reduces CMMI’s authority, a few

payment models may be at risk. Congress

• Payment and delivery reform are largely bipartisan issues. MACRA

received overwhelming support.

• Similar to above, Congress will watch 2017 performance period

closely.

MACRA Delay or Hindrance?

Statutory Curtailing of CMMI?

Key Developments Post-Election Likelihood of Action

• Some in Congress, including President-elect Trump’s HHS nominee
• Rep. Tom Price (R-GA), have expressed concerns regarding the

Cardiac Bundled Payment Model, the Comprehensive Care Joint Replacement Model, and the Part B Drug Payment model.

• It is possible that Republicans will move to limit CMMI's authority in

some areas given their recent attacks on it.

• Key players to watch include Rep. Price, Rep. Greg Walden (R-OR),
• Rep. Kevin Brady (R-TX), Rep. Michael Burgess (R-TX) and Sen. Orrin

Hatch (R-UT) Administration

• A Trump presidency might lead those lawmakers and new staff

at CMS to reduce CMMI's role as a payment reform facilitator and rely more on Congress to drive new payment models forward.

• Will be easier to slow growth moving forward than disrupt what

has been approved. Congress

• Congressional Republicans have been critical of CMMI,

particularly as CMMI has proposed mandatory programs.

• CBO views CMMI favorably due to their believe that it saves CMS
• money. This will make it harder to Congressional Republicans to

limit CMMI’s authority.

Guest Presenter

• Dr. Mark McClellan

Director of the Robert J Margolis Center for Health Policy and the Margolis Professor of Business, Medicine and Health Policy Duke University

Next Steps on Payment Reform Underway

• Centers for Medicare and Medicaid Innovation (CMMI) and Medicare
• Smaller physician groups
• Reforms through and in collaboration with private plans
• State and regional initiatives
• Beneficiary savings
• Cost and quality transparency
• Medicaid reform
• Privately-led initiatives and public-private initiatives
• Healthcare Payment Learning and Action Network (LAN)
• Health Care Transformation Task Force (HCTTF)
• ACLC

MACRA Implementation Timeline

2016 2017 2018 2019 2020 2021 2022 2023 2024+ PQRS Value Modifier EHR Incentives

MIPS

Report on APM Measures 5% Incentive Payment

FFS

+4%* +9%

• 4%*
• 9%

APMs Advanced APMs

Greater than nominal downside financial risk

19

Payment Adjustments Based on MIPS Measures

Som Some Maj ajor r Med edicare Alt lternative Paym yment Mod

• dels

1.Expanded Medicare Shared Savings Program Tracks 2.Next Generation ACO Program* 3.Comprehensive Primary Care + ACO Model 4.Bundled Payment for Care Improvement 5.Comprehensive Care for Joint Replacement* 6.Comprehensive Cardiac, Hip Fracture Care* 7.Oncology Care Model 8.Comprehensive ESRD Care Model* 9.Part B Drug Payment Reform Model

Accountable Care Organizations Specialized Population Management Bundled Episode Payments

Bolded reforms are newly proposed in 2016 Asterisk indicates payment model qualifies for advanced APM bonus

Drug Payment Reforms Not Finalized

LAN APM Survey

The Process

Payer Collaborative & Pilot APM Framework National Measurement Effort

44%

HEALTH PLANS and TWO Medicaid States, responded directly to the LAN.

40

Approximately Representing over

128

100

Million Medicare FFS beneficiaries

38

% of the covered population LAN PARTICIPANTS BY SERVICE LINE TRADITIONAL MEDICARE

2016 LAN Survey

• f the COVERED POPULATION

MILLION AMERICANS, and…

LAN PARTICIPANTS

2016 Results

COMMERCIAL

22%

MEDICARE ADVANTAGE

41 %

MEDICAID

18% % of Healthcare Dollars

TRADITIONAL MEDICARE

30% * 25% …In Categories 3 & 4

25%

*The “25%” above does not include the “30%” traditional Medicare.

Payment Arrangement Growth by Type

1254 474 696 84

200 400 600 800 1000 1200 1400 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016

Total Medicare Commercial Medicaid

Further Steps on Accountable Care Competencies

Health IT Care Coordination Patient Risk Assessment Quality Financial Readiness Governance & Culture Patient Centeredness

Patient Assessment Data Platform for Patient Assessment Patient Assessment Process Population Risk Assessment Dashboard Support use of multiple common analytics tools via an open API Enable user defined variable weights & models for multiple care programs Support a wide diversity of the population Support multiple risk assessment models based on business need

Domains Categories Competencies

23 16 26 27 24 16 31

“To accelerate the successful adoption of accountable care”

MISSION:

ACLC: 2017 Plan

Provider Transition Glide Paths Case Study Briefs Industry Resource Center

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