Health Care Matters | November 15, 2024
Post Election Policy Pulse
Monitor Trump’s Cabinet and Staff Nominations
To monitor Trump’s cabinet and staff nominations, we refer you to the following sources that are being updated as new announcements are made:
Tracking Trump’s Cabinet and Staff Nominations (The New York Times)
Tracking Trump’s Cabinet picks (Politico)
The Impact of Republicans Controlling the White House, Senate, and House
Republicans controlling the White House, Senate, and House next year has impacts on the outlook of the lame duck session this year. For more insight on what to expect in the coming weeks, read the following:
Congress Eyes 'Site-Neutral' Pay Bills for Lame-Duck Session (Modern Healthcare)
A ‘Lamer-than-Usual’ Lame Duck? (Politico)
Lame Duck Session Begins (McDermott+)
ACO REACH Model: Performance Year 2023 Financial and Quality Performance Results’ Highlights
CMS released the program year (PY) 2023 ACO Realizing Equity, Access, and Community Health (REACH) results, showing that the model has made significant strides in both improving healthcare quality and achieving financial savings, with particularly strong performances from ACOs focused on high-needs populations and those taking greater financial risk. Key outcomes include:
Quality score improved overall. High Needs ACOs performed particularly well (average quality scores of 86.73%) compared to Standard/New Entrant (average of 78.55%).
ACOs generated $1.643 billion in gross savings, with net savings reaching $694.6 million for CMS and $948.4 million for ACOs. This is a significant increase over PY 2022.
ACOs in the Global Risk option performed better than the Professional Risk option, with 79% earning shared savings compared to 67%, respectively.
Length of time in the model mattered. ACOs that started in 2021 generated the greatest amount of savings for the model ($575.7 million), followed by the 2022 cohort ($216.5 million), with the 2023 cohort generating the least amount of savings ($108.5 million).
A more detailed evaluation report for PY 2023 is expected in Summer 2025. This report will offer insights into the broader impact of the model, including comparisons to control groups. These evaluation results typically vary from the benchmark-based financial outcomes.
Read more here.
Why It Matters
The PY 2023 financial results for the ACO REACH model are significantly more favorable than those from PY 2022. In PY 2022, while there were net savings to CMS, the savings rate was lower compared to PY 2023, and the CMMI evaluation, which compares model spending to a control group, did not show savings. This type of evaluation, which is key to determining whether a model will be expanded, has not yet demonstrated the savings or quality improvements required for broader adoption of ACO REACH. In contrsast, the PY 2023 benchmark-based financial results show stronger performance, with $1.643 billion in gross savings and $694.6 million in net savings to CMS.
Given the model’s planned end date of 2026, REACH ACOs that are currently participating in the global risk track are understandably concerned about what will happen next. Unlike the MSSP (Medicare Shared Savings Program), which lacks a global risk option, the end of ACO REACH without either an extension or a new model from CMMI could represent a step backward for ACOs that are taking on significant financial risk under the current model. Importantly, the Trump administration has shown strong interest in advancing these types of value-based care models in the past, particularly those that emphasize global risk. The continuation and possible expansion of ACO REACH could have significant implications for the future of value-based care. The evolution of the policy landscape will be critical for REACH ACOs as they plan beyond 2026.
Where We Are Listening To
The Heart of Healthcare Podcast: What a Trump Presidency Means for Healthcare
Aneesh Chopra, former U.S. Chief Technology Officer and author of “Innovative State: How New Technologies can Transform Government," joins host Steve Kraus to talk about what we can expect in Trump's second term.
Where We Are Reading
Re-imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center “Hackathon”
The Innovation Center hosted three Hackathons in August 2024, bringing together diverse stakeholders to generate creative and actionable ideas for sustainably transforming rural health systems. They published a report summarizing key themes and actions the Innovation Center may explore to advance and re-imagine health care in rural, Tribal, frontier, and geographically isolated areas.
Read more here and stay tuned next week for a Coral blog on the report!
Where We Are Going
Navigating Health Policy Post-Election: What Lies Ahead
Join Milliman at 1:00PM ET on Tuesday, November 19th, for an exclusive post-election webinar, "Navigating Health Policy Post-Election – What Lies Ahead?" where they’ll dive into the crucial health policy issues shaping the future. Register Here.
CMS Leadership National Call
CMS is hosting a National Leadership Call on Wednesday, November 20th, from 2:00-3:00PM ET to discuss CMS’ accomplishments and express thanks to their partners for helping them implement their Strategic Plan and key initiatives over the past several years. Register Here.
Remembering Jeff Micklos
It is with heavy hearts that we remember and honor the life of Jeff Micklos. Jeff was a dynamic and passionate leader whose contributions to the health care system have left an indelible mark. His career was defined by his unwavering commitment to transforming health care and he played a pivotal role in advancing policies and initiatives that improved the quality and accessibility of health care for patients.
Beyond his professional achievements, Jeff was known for his boundless energy and enthusiasm. His innovative thinking and relentless pursuit of excellence inspired everyone around him. His exceptional leadership brought people together, fostering collaboration and driving progress across the healthcare community.
Jeff’s legacy will continue to shape and inspire the healthcare field. His work has paved the way for future advancements, and his spirit of innovation and compassion lives on in all who had the privilege of working with him.
As we reflect on Jeff’s life, we extend our deepest condolences to his family and friends. Jeff will be greatly missed, but the impact he made on the healthcare system—and on all the lives he touched—will endure for years to come.