Value-Based Care Providers, Organizations Call on CMS to Support Independent Practices

Laura Joszt

A group of 7 organizations, including Aledade, the American Academy of Family Physicians (AAFP), and the Texas Medical Association, is urging CMS to support independent physicians and practices in the move to value-based care.

The letter, which was sent to CMS Administrator Seema Verma, is asking for the agency to provide more opportunities for independent practices as value-based programs drive consolidation.

“Physicians—especially independent physician practices—are the lynch pin of our nation’s health care system,” the organizations wrote. “They have repeatedly demonstrated their superior ability to generate positive results in value-based care arrangements, both in improved health outcomes and reduced costs. They are the most powerful tool we have to foster an affordable, accessible system that puts patients first.”

They provided 4 ways CMS can support independent practices:

1. Prioritize physician-led advanced alternative payment models.
These include physician-led accountable care organizations and other approaches to achieve improved outcomes for patients, greater value, and the preservation of independent clinical practice.

New payment models should offer greater reward as practices take on greater risk, and that risk should be proportional to the finances of the independent practice. The group also called on CMS to provide more predictable and accurate benchmarks.

2. Establish a level playing field within local markets, promoting patient choice and competition.

The agency can level the playing field through policies that create payment parity across practice settings and by prohibiting anti-competitive abuses of market power, such as data blocking.

3. Re-inject competition into Medicare Advantage markets by lowering barriers to entry by physician-led groups.

The group wants CMS to consider a Centers for Medicare and Medicaid Innovation demonstration for providers to who want to offer Medicare Advantage to contract directly with the agency. Such a move would allow these providers to focus on the latest innovations in population health and would facilitate greater competition in the Medicare Advantage market by removing key barriers.

4. Support consumer-directed care through models that encourage beneficiaries to participate in their own healthcare decision making and to be rewarded for doing so.

One way CMS can involve consumers in their care is by empowering providers in value-based care models to waive or reimburse patient cost sharing for recommended services, thus creating an incentive program for patients. Through such a model, patients can share in savings.

“As CMS refocuses its innovation portfolio, we … encourage you to expand opportunities for physicians and physician-led groups to take financial responsibility for their patients,” wrote Aledade, AAFP, CAPG, ChenMed, Iora Health, Medical Group Management Association, and Texas Medical Association.
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