Overview

Since the passage of the ACA most of the public health policy debate has addressed issues of financing and coverage, including Medicaid expansion, CHIP extension and funding of the Obamacare exchanges/marketplaces. The press has covered prominently battles over these issues that have been raging in the courts, in state legislatures, the Congress and on the campaign trail. After all of this and even with the repeal of the individual mandate, much of the financing and coverage provisions of the ACA still stand.

Less prominent in the public forum, but as profound in its impact on the future of the nation’s health system has been the ongoing evolution of the nation’s health care payment and delivery system. These changes have been driven by federal (Medicare and Medicaid) payment policies, but also by organic changes emerging from the private sector. If there are themes in this complex and somewhat uncoordinated movement they would be (1) moving from fee-for-service to varieties of value-based payment, (2) seeking to achieve the triple aim (improving the experience of care, improving the health of populations, and reducing per capita costs of health care), and (3) continuing industry horizontal and, more recently, vertical consolidation.

While it is generally agreed that the ACA could have done more to contain health care cost, especially with the recent repeal of the Independent Payment Advisory Board (IPAB), it did create the Center for Medicare and Medicaid Innovation (CMMI) which put in place a broad array of experimental payment programs. Concurrently many private payers, both self-insured employers and health plans, are implementing various innovative payment programs that, in general, shift substantial risk to contracting network providers. Leading initiatives in this context include a variety of accountable care and bundled payment models. Increasingly providers are participating in multiple value-based payment programs and are seeking to find ways to coordinate them from a clinical and operational perspective.

Concurrently Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to replace the Sustainable Growth Rate (SGR). MACRA changes the way that Medicare rewards clinicians for value over volume, streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS) and gives bonus payments for participation in eligible alternative payment models (APMs). MedPAC has now raised fundamental questions about the MIPS program. Now the Physician-Focused Payment Model Technical Advisory Committee (PTAC) is in the process of making recommendations regarding qualifying alternative payment models to CMS.

Finally, after the interim leadership of Tom Price at HHS, the new administration has finalized its health care leadership: Alex Azar at HHS, Seema Verma at CMS and Adam Boehler at CMMI. At the same time the administration is seeking input on the future role of CMMI. Most recently both Azar and Verma has made statements supportive of value-based payment. In coming months as the administration acts on PTAC’s APM recommendations and Boehler’s leadership CMMI takes shape, the administration’s approach will become clearer.

At the same time private payors, both employers and health plans, are developing and implanting their own value-based payment models. And the industry continues to consolidate. Traditional horizontal mergers continue as health systems come together and physician practices merge. Many medical practices are now owned by hospitals. Health plans, led by United’s Optum unit, are also acquiring medical practices. Now the new rage is vertical mergers — examples include CVS/Aetna, Walmart/Humana and UnitedHealth/Catamaran — and the attention grabbing announcements made by Amazon, Berkshire Hathaway and JPMorgan regarding the forming of new companies to manage the care of their employees.

In this complex environment, we have decided to bring our major payment and delivery reform events, the ACO Summit, the Bundled Payment Summit and the MACRA Summit, together in the consolidated ACO, Bundled Payment and MACRA Summit. No longer does it make sense to gather around single value-based payment initiatives.

Our faculty of over 100 includes many of the movers and shakers in the value-based payment movement. Leaders making keynote addresses include representatives of CMS, CMMI, major health plans and innovative health systems and physician organizations. In our 20 concurrent mini summits, many technical issues in implementing and coordinating multiple, sometimes conflicting value-based payment will be addressed and case studies in successful accountable care, bundled payment and other valuebased arrangements will be presented.

WHO SHOULD ATTEND