The NAACOS Fall 2021 Conference was the first live meeting that the Healthmonix team attended since HIMSS 2020 was cancelled in March of that year. It was certainly reinvigorating to meet in person, discuss the state of payment models, and hear from CMS regarding their vision.
The conference brought together accountable care organization (ACO) representatives, NAACOS leaders, CMS officials and vendors to the industry. Even with masks, ideas and opinions flowed.
CMS / CMMI was very represented in the meeting sessions. CMS COO Jon Blum outlined the agency’s vision for value-based care. Key insights from Jon and others from CMS included:
- Stepping back to evaluate a more comprehensive, coordinated approach to value-based care models. There is a definite desire to simplify the number and interaction of the models being supported.
- CMMI is a branch of CMS that is commissioned to test models and determine the effectiveness of each. Those that don’t achieve the desired outcomes will be closed, while others will carry on into the mainstream of CMS models.
- Health equity is a focus of CMS. We don’t have good data on the true impact of health equity at this point. However there does seem to be consensus that the current programs tend to have more participation in higher income and disproportionately Caucasian patient populations. There were some ideas posited in the 2022 PFS Proposed Rule which are under consideration. One area gaining traction is the collection of beneficiary demographic data, as part of quality reporting, to determine the impact of health equity.
Despite health equity getting a lot of attention, there is not much action yet. Since ACOs disproportionately enroll Caucasian, mid-/upper-income populations, this was discussed in terms of meeting the 70% threshold for quality reporting. ACOs will get data from their big EMRs (because it's more straightforward), but the systems that are in the more rural / lower-income areas, that require more effort to incorporate, may be left out since they are not needed for the 70%.
- While ACOs clearly do not like the idea of collecting eCQMs and all-payer quality data, CMS stated that burden alone is not a reason to curtail quality measurement collection.
- CMS recognizes the challenges of full-risk programs as participants in these programs are incentivized to add diagnosis codes to represent higher risk patients. Some feel there is opportunity for 'gaming' the system. In addition, these programs tend to favor more well-funded organizations and potentially exclude others.
Blum stated, “I don’t think that CMS will be promoting models that have more risk, just for the sake of having more risk,”. He also said that tasks that ACOs view as burdensome won’t be dropped just because they are challenging. If there is a need for certain data collection or reporting, it will be required. For example, starting to track health equity data and support interoperability may be required in coming periods.
Additional insights from the conference:
- Dr. Robert Pearl, a thought-leading physician, reminded us of the long road ahead of us towards getting to healthcare that is more effective, that reduces cost and provides patients with satisfactory care. He focused on the overspending, the mis-incentives, and the lack of coordination in our current system. It’s certainly frustrating that 20 years after the publishing of Crossing the Quality Chasm by the Institute of Medicine, we still have such widespread issues in our system.
- There was a great session presented by three ACOs that have embraced the need to collect all-payer data for eCQM reporting. These ACOs laid out the path towards success in collecting, improving, and reporting the data needed. They noted that the path to all-payer data will need to be completed at some point, so it’s better to get started in a methodical approach so that the ACO is ready to report the needed data at the needed time. While Healthmonix shares similar sentiments, we recognize the need to accommodate ACOs no matter where they are in transitioning to eCQM reporting. We provide gradual and accelerated tracks through our APP Impact, with the option to track performance on Web Interface measures alongside eCQMs, or simply move full steam ahead with eCQMs.
It will be interesting to see where the 2022 PFS Final Rule lands. NAACOS is definitely pushing hard for some changes to the Proposed Rule. Until we see where CMS lands for the upcoming year, there is still much up in the air. Stay tuned for developments and register for our upcoming webinar: Insights from NAACOS Fall 2021 Conference, where we’ll provide more detailed takeaways from the meeting.