In the News: September 8-14, 2016

Sg2 is dedicated to helping our clients interpret the latest news and trends in health care. Below you’ll find our analysis of this week’s key industry headlines, along with links to related Sg2 resources.

ACA Health Insurance Expansion Impacts Consumers’ Costs

The Commonwealth Fund released a study on the impact that the ACA health insurance exchanges have had on out-of-pocket costs and premiums for consumers. Consumers in states with the greatest increase in enrollment in their ACA marketplaces saw the greatest decline in out-of-pocket and premium spending relative to before the ACA. The reductions were most impactful for those with incomes between 250% and 399% of the federal poverty level, those who were eligible for subsidies, and those who were previously uninsured. Despite these advances, premium increases and cost sharing continue to place a strain on consumers, as health care expenditures make up a significant amount of consumer spending. This study found that the median US family spent nearly 11% of its income on health care, with total out-of-pocket expenses exceeding $5,000.

Read the Sg2 report Engaging the New Health Care Consumer to learn more about the rise of consumerism in health care and the increased attention that consumers are paying to health care costs.

CMS Proposes More Options for Clinicians Under MACRA

On September 8, CMS indicated that they will double the number of options for clinicians under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), at least for the first performance year. Under the proposed rule released in April, CMS had proposed 2 options—Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Model (aAPM) Incentives—to adjust clinician payment for Medicare Part B items and services. With the new announcement, there will now be the following 4 options in 2017 to avoid 2019 negative payment adjustments:

  • Option 1: Submit some data in 2017. Clinicians choosing this option will not be eligible for positive payment adjustments.
  • Option 2: Submit partial year data across all MIPS performance categories for 2017. Clinicians choosing this option are eligible for “small” positive payment adjustments.
  • Option 3: Submit full calendar year data across all MIPS performance categories for 2017. Clinicians choosing this option are eligible for “modest” positive payment adjustments.
  • Option 4: Qualify for aAPM Incentives by participating in aAPM(s) and meet thresholds for percent of revenue tied to an aAPM. Clinicians qualifying for this option receive a 5% lump sum bonus payment in 2019.

*Clinicians who do not report any data for 2017 may be subject to negative adjustments for their Medicare Part B payment rates in 2019.

While there is some uncertainty around the details of implementation for MACRA until the release of the Final Rule this fall, clinicians should prepare for this overhaul of Medicare Part B payment. For more on MACRA, listen to Sg2’s Understanding MACRA: Key Implications for Physicians and Hospitals webinar and join us at noon CT on September 20 for the latest installment of the MACRA Deep Dive series, focusing on aAPMs.

CMS Modifies and Reopens Track 1 of Accountable Health Communities Model

On September 8, CMS announced a new Funding Opportunity Announcement (FOA) for Track 1 of the AHC model. Back in January, CMS announced the Accountable Health Communities (AHC) model—a first-of-a-kind, $133 million funding opportunity—for “bridging organizations” to connect Medicare and Medicaid beneficiaries to community services that address their social and economic needs. The original FOA for the AHC Model closed on May 18. In the recent announcement, CMS modified Track 1 of the AHC model to be more appealing to applicants by “reducing the annual number of beneficiaries applicants are required to screen from 75,000 to 53,000; and by increasing the maximum funding amount per award recipient from $1 million to $1.17 million over 5 years.” The modified Track 1 AHC model is open to all applicants, and previous applicants to the AHC model would need to re-apply to be considered for the modified Track 1 AHC model. The new FOA will accept applications at (FOA # CMS-1P1-17-002) until November 3, 2016.

The AHC model is an opportunity to begin investing in the foundational infrastructure for population health. To learn more about the AHC model, see the updated Sg2 expert insight New Funding Opportunity Connects Community Services to Health Systems.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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