Shannon Muchmore Oct. 29, 2019
HHS Secretary
Alex Azar on Tuesday hinted at further pushes from CMS on value-based care,
including population health benefits like those newly allowed in Medicare
Advantage and per-member per-month payments for a patient's total cost of care.
Speaking at the
Milken Institute Future of Health Summit in Washington, Azar gave the example
of paying a provider $14,000 a year for all of a person's health costs —
regardless of how much care is actually required.
"If [a
provider] can help that patient — not through gate keeping, not through
rationing — but through coaching, advising and guiding," they can reap
profit, he said.
CMS has
developed a primary care program pushing more downside risk on providers, but
last week said the start of the model would be pushed back a year. One path on
that program includes a flat monthly fee for some patients with chronic
illnesses. The first participants in the five-year model will now start January
2021.
The agency also
said last week organizations already in the Medicare Shared Savings Program
would be allowed to participate in the new model, news cheered by ACOs.
Azar also
touted CMS models on kidney care and opioid misuse and promoted non-medical
benefits that can help patients with social determinants of health. Several insurers ramped up those
benefit types for their 2020 Medicare Advantage plans, including offering pest
control services and transportation assistance to grocery stores.
"They
might say 'you know what I can keep this senior out of the nursing home and
mobile, independent, out of the hospital, by investing and getting her an air
conditioner, get her meals delivered, maybe have a home health aide check in
occasionally,' " Azar said.
He also
defended the Trump administration's handling of the Affordable Care Act,
deriding the law as "fundamentally broken."
Still, he added
that "while we have this program we're going to run it as best we can for
the American people."
A ruling that
could overturn the landmark law is expected any day now from the Fifth Circuit
Court of Appeals. In December, a Texas judge ruled the ACA did not pass
constitutional muster without its individual mandate penalty. The case is
almost certain to eventually end up before the U.S. Supreme Court, possibly
while the 2020 presidential election is in full swing.
Azar did
not discuss the pending court case and was not asked about it. Last week, CMS
Administrator Seema Verma ducked lawmakers' questions
on whether the administration has a backup plan if the law is struck down.
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