Washington, D.C. – Today, Representatives Darin LaHood (IL-18), Suzan DelBene (WA-01), Peter Welch (VT-At-large), and Brad Wenstrup (OH-02) reintroduced the Value in Health Care Act, a bipartisan bill that will make commonsense changes to the program parameters of Medicare’s Alternative Payment Models (APMs). The changes will increase participation in these value-based health programs that are designed to improve the quality of care and health outcomes for seniors while lowering costs.

In 2017, a U.S. Health and Human Services Inspector General report found that 98 percent of Accountable Care Organizations (ACO), after participating for three years, met or exceeded quality measures and outperformed regular fee-for-service providers on 81 percent of quality measures. However, in 2019, after changes were implemented to the ACO program, fewer providers participated for the first time since its inception in 2012.

In 2019, ACOs participating in Medicare’s ACO program achieved their highest annual savings since the program’s start in 2012, producing $1.4 billion in net savings. Since 2012, ACOs have saved Medicare a net $2.5 billion.

The Value in Health Care Act would make the following changes to the APM and ACO parameters:

  • Encourages participation in the Medicare ACO program by increasing the percent of shared savings beginner participants receive. Program changes under the previous administration decreased shared savings, making the program less attractive.
  • Modifies risk adjustment to be more realistic and better reflect factors participants encounter like health and other risk variables in their communities.
  • Removes barriers to ACO participation by eliminating arbitrary program distinctions so all participants are participating on a level playing field.
  • Supports fair and accurate benchmarks by modifying performance metrics so participants aren’t competing against their own successes in providing better care. 
  • Provides greater technical support to ACO participants to cover the significant startup costs associated with program participation.
  • Incentivizes participation in Advanced APMs by extending the annual lump sum participation bonus for an additional six years.
  • Corrects arbitrary thresholds for Advanced APM qualification to better reflect the existing progress of the value-based movement and to encourage bringing more patients into this model of care.
  • Addresses overlap in value-based care programs so that APM overlap within markets complement each other rather than cause confusion.
  • Sheds light on healthy equity by directing the GAO to study health outcomes of seniors assigned to ACOs compared to seniors in regular fee-for-service.

“The Value in Healthcare Act is a commonsense proposal that includes substantive reforms to encourage and support greater participation by healthcare providers in ACO’s, particularly in our rural communities in central and west-central Illinois,” said Rep. LaHood. “By incentivizing the use of these value-based health models that support coordinated care between doctors, hospitals, and other healthcare providers, this legislation will improve healthcare access and the quality of care for seniors and patients across my district, which is critical as we recover from COVID-19.”

“Physicians and hospitals participating in APMs are driving the change in health care we so desperately need. The Value in Health Care Act makes sensible modifications to the existing APM parameters and encourages more providers to participate. This ultimately helps seniors by improving the quality of care and outcomes,” said DelBene. “ACOs in Washington were critical to providing coordinated care for seniors during the pandemic and we should continue to incentivize these models in our communities.”

“Accountable Care Organizations are vital to our work to drive down health costs in this country — which are far too high. By using a more collaborative approach to health care, we can improve both quality and efficiency in patient access and care. We need to encourage value, not volume of services,” said Welch. “ACOs deliver better care for a better price, and we should continue working to make sure that they succeed.”

“It’s important that we give health care providers additional flexibility if we’re going to successfully transition our health care system into one that prioritizes the value of positive patient outcomes over just the sheer volume of services provided,” said Wenstrup. “Our bipartisan legislation helps accomplish that and puts our health care system on a better track to keep patients healthier for lower costs.”

Under MACRA, providers participating in quality improvement programs can choose between an APM or the Merit-Based Incentive Payment System (MIPS). Both programs incentivize providers to improve quality and contain costs.