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Representative Darin LaHood

Representing the 18th District of Illinois

LaHood, DelBene, Welch Introduce Bipartisan Legislation to Incentivize Value-Based Healthcare

July 24, 2020
Press Release

WASHINGTON, DC – Today, Representatives Darin LaHood (IL-18), Suzan DelBene (WA-01), and Peter Welch (VT-At-large) introduced the Value in Healthcare Act, a bipartisan bill that will make commonsense changes to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The bill specifically amends many of the program parameters of Medicare’s Alternative Payment Models (APMs). The changes will increase participation in Accountable Care Organizations (ACO) and support these value-based health programs that are designed to increase the quality and coordination of care and improve health outcomes for seniors while lowering costs. 

“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 programs that support coordinated care between doctors, hospitals, and other healthcare providers, this legislation will improve healthcare access and the quality of care for our seniors, which is critical now in our fight against COVID-19. As we continue to battle this virus, I am committed to working with my colleagues to get this bill passed to support our communities and seniors in IL-18.”

“Physicians and hospitals participating in APMs are driving the change in healthcare we so desperately need. The Value in Healthcare 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 Rep. DelBene. “The ACOs in Washington are doing the right thing by making sure seniors, who are isolating to protect themselves from COVID-19, are accessing nutrition and pharmaceutical prescriptions. This is the exact kind of care coordination that we need – it’s even more critical during the public health emergency.”

“To increase the quality of care across the country we need to encourage value, not volume,” said Rep. Welch. “These commonsense changes will reward providers for delivering the value that patients need and expect. ACOs deliver better care for a better price, and we need to do everything we can to make sure that they succeed.”

Background

The Value in Healthcare Act makes the following changes to the APM and ACO parameters:

  • Encourages participation in the Medicare Accountable Care Organization (ACO) program by increasing the percent of shared savings beginner participants receive. Recent program changes 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 playing on a level playing field.
  • Support 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.
  • Correcting 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.

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, outcomes, and cost containment.

The legislation is supported by numerous healthcare stakeholders including the American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, American Medical Group Association, Medical Group Management Association, and National Association of ACOs, among others. You can read their letter of support here.

A section-by-section of the bill can be found here. The full bill text is available here.

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