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What We’re Watching: December 10, 2019

MEDICARE ADVANTAGE NEWS

CMS released its annual preview of Medicare Advantage 2021 rates, which included a strong 4.5 percent trend increase. These estimates are likely to change when final rates are published next Spring. Typically the final rates are adjusted upward from the preview numbers.

What we’re saying: In addition to the positive Medicare Advantage 2021 preview rates, we are expecting additional positive actions on Medicare Advantage, based on the President’s Executive Order in October. The EO will likely advance policies related to network adequacy, telehealth, and social determinants of health, among others. This ties into Fitbit’s recent announcement that it is preparing to offer wearables as Medicare Advantage benefit with three insurers in 2020. Premier is actively working with members to optimize their success in Medicare Advantage and other risk-based models.

GETTING READY FOR PAMA

As many of you know, CMS is expecting providers to use 2020 to prepare to be compliant with the Protecting Access to Medicare Act (PAMA) on January 1, 2021. Under PAMA, providers need to use a clinical decision support (CDS) tool when prescribing advanced diagnostic imaging services (e.g., magnetic resonance imaging, computed tomography and nuclear medicine) so as to receive Medicare reimbursement.

What we’re saying: In August, Premier’s Catrina Funk and Aisha Pittman shared an overview of the requirements detailed in PAMA and the virtues of Premier’s CDS solution – Stanson Health. Jonathan Slotkin, Chief Medical Officer of Contigo Health, also recently published a blog on CDS.

A NEW DIRECT CONTRACTING MODEL

CMS released a Request for Applications (RFA) for the 5-year, Direct Contracting (DC) model on November 25. The DC Model represents CMS’ next step in risk-sharing arrangements, building on lessons learned from the Medicare Shared Savings Program and the Next Generation ACO model, and reflects the bipartisan focus on shifting risk from public payers to private entities.

What we’re saying: Over the last decade, Premier’s Population Health Management and Bundled Payment Collaboratives have helped hundreds of hospitals and health systems evaluate and succeed in alternative payment models. Premier hosted a webinar to review the newly available details.

RURAL ACO IMPROVEMENT

Late last month H.R. 5212, Accountable Care in Rural America Act, was introduced by Congressman Jodey Arrington and Congresswoman Suzan DelBene. It is the companion bill to the Rural ACO Improvement Act (S. 2648), which benefit ACOs, particularly in rural areas, by removing ACO-assigned beneficiaries when setting the regional spending benchmark in the Medicare Shared Savings Program.

What we’re saying: You may recall that in October, Premier expressed support for the Rural ACO Improvement Act. In November, Premier joined 13 other healthcare organizations in urging Congress to pass H.R. 5212 in 2019.

IN CASE YOU MISSED IT


What We’re Watching is a bi-weekly blog focused on the current events Premier is following and their relevance to the work of Premier and its members. Check out our last update!

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