MedPAC Likely to Recommend CMS Simplify Alternative Payment Models

A congressional advisory panel will likely recommend that CMS improve coordination among its alternative payment models and reduce the total number of models it operates, including accountable care organizations and bundled payments. During a Medicare Payment Advisory Commission meeting on Thursday, experts said the changes would encourage providers to deliver care more efficiently and might lower Medicare spending, depending on how Congress and CMS carry out the recommendation. The commission’s staff found that more effective payment models could boost care coordination, improve health outcomes and potentially reduce premiums and out-of-pocket costs for Medicare beneficiaries.

CMS Pushes Pause on Controversial Geographic Direct Contracting Model

The Biden administration is reviewing a controversial payment model that would tie Medicare payments to spending and quality for an entire region. The Centers for Medicare & Medicaid Services’ (CMS’) webpage for the Geographic Direct Contracting model said it is currently under review in an update posted Monday. The agency did not immediately respond to a request for comment on the reason the model was put under review nor for how long it would happen.

Permanent Medicare Telehealth Expansion Gains Lawmaker Support

Looser telehealth restrictions for Medicare beneficiaries enacted for the Covid-19 pandemic should be made permanent, the leaders of a key House health committee said. The expansion of telehealth, where health-care providers treat patients using remote technology, over the past year has proven that many of Medicare’s tight restrictions on the service should end, Anna Eshoo (D-Calif.), head of the Energy and Commerce Committee’s health panel, said Tuesday. Telehealth can address matters such as specialist shortages by connecting patients with doctors remotely, she said. “It’s time to make Medicare reimbursement for telehealth permanent,” she said.

Former Senate Aide Elizabeth Fowler to Lead CMS Innovation Center

Elizabeth Fowler will be the new director of CMS’ innovation center, per the HHS directory, confirming weeks of speculation the health policy expert and Obama administration alum would be taking on the role. As head of the Center for Medicare and Medicaid Innovation, Fowler will direct federal government efforts and run payment models in a bid to inject value into the U.S. healthcare system. Fowler has previously held leadership roles at HHS and helped draft and implement the Affordable Care Act, the law underpinning much of President Joe Biden’s health policy agenda.

Achieving Success in Medicare’s Highest-Risk ACO Program: One ACO’s Story

Southwestern Health Resources Accountable Care Network has been a top performer in the Next Gen ACO model, and a senior executive lays out the reasons why.

Feds Pay Three Times as Much for Drugs in Medicare Than Medicaid

Brand name drugs covered by Medicare’s outpatient plans are three times more expensive on average than the same drugs covered through Medicaid, the Congressional Budget Office found in a report released Thursday. The report highlights the massive role discounts play in the payment pipeline. Most entities don’t end up paying the base list price for a drug. What a government, employer, or individual ultimately spends boils down to how much leverage they have to reap discounts from drug companies.

Medicare’s Addiction Coverage Gaps Prompt Calls for Change

Access to affordable care is a key to treating people with addiction, but adults 65 and older may have a hard time getting Medicare to cover the treatment they need. Advocates for people with addiction say the federal program is falling short on covering some of the standard intermediary treatments recommended for substance use disorders and they’re hoping the new Congress will be open to making some legislative changes to fix a problem that’s been heightened by the opioid epidemic and exacerbated by Covid-19.

Medicare Fee-for-Service Utilization Decreased Dramatically during the COVID-19 Pandemic

Healthcare utilization among Medicare fee-for-service beneficiaries decreased dramatically during the spring of 2020 compared to the spring of 2019, finds a new Avalere analysis. This speaks to the impact that the COVID-19 pandemic has had, with utilization decreasing during the first three months of the public health emergency (March, April and May) and showing a dramatic decline in April in particular. The impact of delayed or avoided care on the health status of Medicare beneficiaries will likely be further examined over the following months and years, as there could be lasting effects, even as the pandemic recedes.

Biden Administration to Undo Medicaid Work Requirements

The Biden administration is moving to roll back Medicaid work requirements in its latest effort to undo a controversial Trump-era policy. Federal health officials planned Friday to inform 10 states that they would revoke permissions granted by the Trump administration to impose such requirements, according to a Biden official who spoke on condition of anonymity to discuss internal plans. Officials were also set to withdraw the past administration’s invitation for states to apply for approval for work requirements.

CMMI’s Geographic Direct Contracting Model Needs an Overhaul, Experts Say

Consumer advocates, accountable care organizations and several experts think CMS’ Center for Medicare & Medicaid Innovation should delay its Geographic Direct Contracting model—dubbed “Geo”—until it resolves a number of issues that could create significant confusion among Medicare beneficiaries and operational and financial challenges for providers.