Aug 16, 2023 –  The U.S. healthcare system is pushing towards value-based care, with the introduction of the groundbreaking Value in Health Care Act of 2023. With healthcare organizations and medical professionals showing unwavering support, the proposed legislation “would make commonsense changes to Medicare’s Alternative Payment Models (APMs) program to incentivize greater participation in value-based health programs.”

Overall, the legislation is designed to increase participation in accountable care organizations (ACOs) while lowering costs. Representative Suzan DelBene (D, Oregon) is a cosponsor of the bill, along with Representatives Darin LaHood (R, Illinois), Kim Schrier, MD, (D, Washington), Brad Wenstrup, DPM (R, Ohio), Earl Blumenauer (D, Oregon), and Larry Bucshon, MD (R, Indiana).

“Physicians and hospitals participating in Alternative Payment Models are leading the changes our health care system needs to focus on value instead of volume,” DelBene said in the announcement. “Providers should be paid based on the quality of the care they deliver, not the quantity of services. The Value in Health Care Act would encourage more providers to join these models and accelerate this change, leading to improved quality of care and health outcomes for seniors.”

What The Value in Health Care Act of 2023 Entails

At its core, the Value in Health Care Act would make changes to APM and ACO parameters. The change include: 

• Encourages participation in the Medicare ACO program by increasing the percentage of shared savings beginner participants receive. Program changes under previous administrations 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 two 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.

Should the legislation get the green light, practices would witness a smoother transition from traditional fee-for-service models to value-based care. The 5% advanced APM incentive payment would be extended to help ease this transition. This is a move supported by many, including the Medical Group Management Association (MGMA).

“In light of another round of proposed cuts to Medicare physician reimbursement, ensuring group practices have the necessary support to succeed in value-based care arrangements is paramount,” MGMA Senior Vice President of Government Affairs Anders Gilberg said in a statement. “MGMA looks forward to working with Congress to ensure the passage of this crucial piece of legislation.”

The Act would also freeze the 50% revenue threshold that physicians in value-based care models must meet to qualify for the incentive payments. This is a move also support by many, including MGMA and the American Medical Association (AMA).

In a united show of support, MGMA, AMA, and numerous other significant entities co-signed a letter published by the American Hospital Association on July 27, underscoring the bill’s potential to steer American healthcare towards a more value-based payment horizon.