Health Care Matters | August 23, 2024
Negotiating for Lower Drug Prices Works, Saves Billions
Beginning January 1, 2026, recently negotiated lower prices for some of the most expensive and regularly dispensed drugs in the Medicare program will go into effect for individuals with Medicare Part D prescription drug coverage. The 10 drugs selected are often used to treat heart disease, diabetes, and cancer. Roughly 9 million people with Medicare use at least one of the 10 drugs selected. Medicare estimates 22% (or $6 billion) in savings had these new prices been in effect the previous year.
For more information regarding the newly negotiated prices, visit: Centers for Medicare & Medicaid Services (CMS) Negotiated Prices Fact Sheet
Why It Matters
This is the first time Medicare has negotiated lower drug prices since Part D was first implemented in 2006. CMS will select up to 15 more drugs for negotiations under Part D for 2027 by February 1, 2025. In addition, starting next year, there will be a $2,000 out-of-pocket cap on prescription drug costs for Medicare Part D enrollees.
Elevance Health Forms Mosaic Health with Clayton, Dubilier & Rice
Following announcement to form a strategic partnership in April, Elevance Health has officially secured a deal with private equity partner Claton, Dubilier & Rice (CD&R) to form Mosaic Health, a primary care company with an advanced model to address the physical, social, and behavioral health of a patient. This partnership will provide primary care services from two of CD&R’s businesses, Millennium Physician Group and digital health services from Apree Health. Mosaic Health will leverage incentives through value-based care arrangements to enable health care providers and allow for more affordable care.
Why It Matters
Trends involving the vertical integration of primary care with payers and consolidation of primary care through private equity continue. The April announcement also mentioned Carelon Health who would provide chronic condition care management, but partnership with Carelon is still pending regulatory approval.
CMS’ Innovation Center Data-Sharing Strategy Initiative to Improve VBC Participation
Given that data is essential to improving patient care and taking financial risk under alternative payment arrangements, the CMS Innovation Center has been exploring ways to better share data and incorporate lessons learned in future models, including identifying new data-sharing needs while safeguarding data security and privacy considerations. As a result of their recent effort, CMS developed six data strategy principles:
Promote access to CMS data
Formulate data-sharing strategy early in model design
Focus on standards
Invest in data tools and resources
Enhance CMS data collection capabilities
Partner broadly to enhance CMS data-sharing capabilities.
For more information regarding this initiative, please visit the HealthAffairs article: Improving Participation In Value-Based Care—The CMS Innovation Center’s Data-Sharing Strategy Initiative
Why It Matters
Data is essential to value-based care transformation and payment model participation and a source of much effort, expense, and, at times, frustration for participants. By engaging in interviews and human-centered design, the Innovation Center is attempting to build better data sharing infrastructure into future tests of change. In addition to data strategies that evolve how CMS shares with model participants, there are considerations for how participant entities, their enabling vendors, participating providers and partners across the community share data to coordinate and improve care.
What We Are Reading
Payer Strategies for Advancing Health Equity Through Value-Based Payment
The Health Care Transformation Task Force released a new resource that highlights case studies and strategies being implemented by Task Force commercial payer members to advance health equity through value-based care and related payment strategies.
Preliminary ACO PC Flex Rate Book Posted
CMS has posted the Preliminary PY 2025 ACO PC Flex Rate Book to the ACO PC Flex website! The Preliminary Rate Book uses base years 2021-2023 and will be used for the prospective primary care payments (PPCP) paid between January and June 2025 to participating MSSP ACOs.
Congratulations!
Congrats to Jeff Micklos, recently named President of the National Association of Accountable Care Organizations!
What we Are listening to
The Fifth Branch: Redefining Mental Health Crisis Response in America
This series from Tradeoffs, in partnership with The Marshall Project, dives deep with the team pioneering this new model, and similar models across the country, to explore the challenges, early successes, and what other cities can learn.
