AMGA Outlines Top Priorities for Healthcare in 2020

The American Medical Group Association (AMGA) outlined their top priorities for health systems and medical groups in 2020 in a letter sent to Congress on January 31st, 2020. “Chief among the group’s recommendations was better claims data access for providers and patients in a value-based care world” (revcycleintelligence.com). Numerous organizations, from small health systems to federal government entities, have indicated that the financial aspect of the current healthcare model is unsustainable. Despite incredibly high spending, Americans report less desirable health outcomes when compared to individuals receiving care in similar countries, according to the Peterson-KFF Health System Tracker.

Value-based care was designed to simultaneously improve patient outcomes and reduce the cost of care. Adoption of value-based care models has occurred at a slower rate than anticipated, even with the introduction of value-based programs through the Centers for Medicare and Medicaid Services (CMS). The AMGA’s letter to Congress details the barriers that they feel prevent wider-spread adoption, including increased access to claims data.

 

Key Takeaways

  1. Timely access to claims data is a key factor in the success of providers and organizations that choose to adopt value-based care models and the lack of access to administrative claims is one of the most frequently cited barriers to taking on financial risk. “Knowing who provided care, what was done, when, and where a treatment was provided is critical for any value-based model to succeed. Without timely access to claims data…providers simply won’t have a complete patient history and will be making care decisions with incomplete information” (revcycleintelligence.com). Patient access to claims data is just as vital to the advancement of value-based care as provider access. When patients have access to their medical claims, it leads to more meaningful conversations with their providers and more engagement in their own care, ultimately resulting in improved health outcomes. 

 

  1. Congress has the opportunity to require the sharing of claims data with providers and their patients engaged in value-based care “by including a provision in an upcoming healthcare legislative package” (revcycleintelligence.com). The AMGA worked closely with the Senate Health, Education, Labor, and Pensions (HELP) Committee “to include a commercial claims data-sharing provision within the Lower Health Care Costs Act from 2019” (revcycleintelligence.com). The provision requires group health plans and payers offering group and individual health insurance plans to utilize application programming interfaces (APIs) to make commercial claims data accessible to providers and patients alike. A broader version of the bill was passed by the HELP Committee and is awaiting further consideration by Congress.

“To further advance value-based care, AMGA also recommended that Congress:

  • Fully implement MACRA by eliminating exclusions from the Merit-Based Incentive Payment System (MIPS) and allowing for more alternative payment model participation through lower participation requirements
  • Update benchmarking for accountable care organizations (ACOs) in Medicare value-based care programs to remove the ACO’s population from CMS’ regional adjustment calculation so organizations are not penalized for making improvements in its market and are not competing against themselves
  • Reform the physician-self referral law to account for value-based care models and preserve access to advanced diagnostic imaging in the medical group setting by maintaining the scope of the in-office ancillary services (IOAS) exception
  • Promote access to telehealth services by creating a national standardized licensing and credentialing system
  • Eliminate coinsurance payment requirements for services billed as chronic care management” (revcycleintelligence.com)

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About Innovista

Innovista Health Solutions is a population health management company that offers management and support services to guide independent physician networks, medical groups, and health systems through the ever-changing landscape of value-based care. With services and toolsets including network development, population health management, delegated services, data reporting, and strategic capital investments, Innovista is structured to help its clients succeed in their Commercial, Medicare, and Medicaid value programs. Innovista is a single resource for physician integrated models to gain access to innovative technology, expert programs, actionable data insights, financial resources, and growth opportunities, to navigate and succeed in value-based and/or risk-based contracts.

 

Innovista Media Contact

Laura Bingham

lbingham@innovista-health.com