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ACOs and Payment Reform



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Joint Press Release Announcing Business Group Participation in the Coalition Against Surprise Medical Billing
The Business Group recently joined the Coalition Against Surprise Medical Billing to urge Congressional leaders to focus on a fair, local, market-based benchmark for surprise medical bills that would protect patients and lower costs for families and taxpayers and reject arbitration proposals that would give a green light to certain out-of-network providers to continue charging exorbitant rates for care.
Aug 13, 2019
Joint Letter to Congress Supporting Passage of the Lower Health Care Costs Act (S. 1895)
The Business Group, in conjunction with other employer groups, sent a letter to all Members of Congress urging them to pass the Lower Health Care Costs Act (S. 1895) that would end the surprise billing crisis via local, market-based benchmark payments, reduce the high prices of prescription drugs, increase transparency and competition, fund America's health care
Aug 7, 2019
Joint Letter to U.S. Senate Supporting Local Market-Based Benchmark Payments in Surprise Billing Legislation
The Business Group, in conjunction with public and private employers, labor unions, and consumers, sent a letter to Senators recommending they adopt local, market-based benchmark payments in surprise billing legislation that would protect patients without undermining network participation or increasing health care costs for all consumers.
Aug 5, 2019
Comments to Senate HELP Committee Leadership with Employer Recommendations for Ending Surprise Billing and Improving Transparency
The Business Group sent Comments to the Senate HELP Committee leadership with recommendations to end surprise billing and improve transparency in health care.
Jun 5, 2019
Congress Considers Surprise Medical Bill Proposals; President Urges Action
Over the past few weeks, House and Senate lawmakers released differing bipartisan proposals and key Committees have held hearings on eliminating surprise medical bills. More of both are likely.
Jun 4, 2019
Testimony to House Ways and Means Health Subcommittee with Employer Recommendations for Protecting Patients from Surprise Medical Bills
The Business Group submitted written testimony to the House Ways and Means Health Subcommittee with recommendations for legislation that protects patients from surprise bills while not raising their health care costs nor jeopardizing the value that provider networks offer them.
Jun 3, 2019
Joint Letter to the U.S. House Ways and Means Health Subcommittee Leadership Recommending Principles for Surprise Billing Legislation
The National Business Group on Health sent a joint letter to the House Ways and Means Health Subcommittee Chair Lloyd Doggett (D-TX) and Ranking Member David Nunes (R-CA) in coordination with a hearing on surprise billing recommending legislation protect patients from surprise medical bills without undermining network participation or resulting in higher health care costs for all consumers.
May 22, 2019
Joint Letter to House Health, Employment, Labor, and Pensions Subcommittee Leadership Recommending Principles for Legislation that Protects Patients from Balance Billing without Undermining Networks or Increasing Costs
The National Business Group on Health sent a joint letter to the House Health, Employment, Labor, and Pensions Subcommittee Chair and Ranking Member requesting that legislation to combat surprise billing focus on protecting patients from surprise medical bills without undermining network participation or resulting in higher health care costs for all consumers.
Apr 2, 2019
Letter to Senate HELP Chair Lamar Alexander (R-TN) with Recommendations to Slow Rising Health Costs and Improve Health Outcomes
The National Business Group on Health sent a letter in response to Senate HELP Committee Chair Alexander's request for information on specific recommendations for Congress and the Administration to slow rising health care costs, improve health outcomes and increase access to information to make informed decisions about health care. Specifically, the Business Group recommended eliminating the ACA's Cadillac Tax, ending surprise billing, supporting HSA-qualified health plan improvements, advancing policies to promote more affordable, financially sustainable prescription drug prices, encouraging and promoting transparency and accelerating payment and delivery reform in Medicare/Medicaid.
Mar 1, 2019
Joint Letter to Senate HELP Committee Leadership Recommending Principles for Surprise Billing Legislation that Won't Undermine Value-Based Networks
The National Business Group on Health as part of the National Coalition on Benefits sent a joint letter to Senate HELP Committee leadership recommending adopting principles when crafting legislation to protect patients from surprise medical bills without undermining access to high-quality, value-based health care networks.
Feb 21, 2019
President Wants to End Surprise Medical Bills; Senators Weigh Legislation
At a White House roundtable with patients last week, President Trump expressed support for protecting patients from surprise medical bills. Typically, surprise medical bills occur when providers balance bill patients for OON emergency care or treatment at in-network facilities by OON providers.
Jan 31, 2019
Press Release and Consensus Statement on Guiding Principles to Protect Patients from Surprise Medical Bills
The National Business Group on Health along with consumers, businesses, and health insurance providers issued a joint press release and guiding principles on protecting employees and other plan participants from surprise medical bills.
Dec 12, 2018
Comments to CMS Administrator Supporting Improvements to the Medicare ACO Program
The National Business Group on Health submitted comments to CMS Administrator Seema Verma supporting a number of proposed improvements contained within the Pathways to Success proposal to overhaul the Medicare Shared Savings Program's (MSSP's) Accountable Care Organizations (ACOs).
Oct 18, 2018
FAA Reauthorization Law to Increase Scrutiny of Air Ambulances
Last week, President Trump signed the FAA Reauthorization Act of 2018 that will increase scrutiny of air ambulance pricing but maintains federal preemption of state consumer protection laws via the Airline Deregulation Act (ADA) of 1978 which explicitly preempts states from regulating the "rates, routes, or services of any air carrier" including air ambulances.
Oct 12, 2018
Bipartisan Senate Plan Seeks to Tackle Surprise Medical Bills
Last week, Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), Chuck Grassley (R-IA), Tom Carper (D-DE), Todd Young (R-IN), and Claire McCaskill (D-MO) unveiled a proposal and draft legislative language to limit balance billing of plan participants (to in-network OOP costs) by OON providers.
Sep 28, 2018
Comments to CMS on a Proposed Rule to Modify the Quality Payment Program (QPP) Supporting Administrative Simplification and Reduced Reporting Burdens
The National Business Group on Health submitted comments to CMS supporting simplifying the QPP program, reducing reporting burden, and encouraging participation in Advanced alternative payment models.
Sep 10, 2018
CMS Proposes to Require Most ACO's to Take on Downside Risk within 2 Years
CMS recently issued a proposed rule, "Pathways to Success", to require upside-risk only ACOs participating in the Medicare Shared Savings Program to take on downside risk within one to two years, with incremental increases in downside risk acceptance thereafter.
Aug 17, 2018
Joint Letter to Senate Committee on Commerce, Science, and Transportation Leadership Urging Inclusion of Critical Regulation Reform of Air Ambulances in the FAA Authorization Bill
The National Business Group on Health as part of larger effort on behalf of insurers, employers and others sent a joint letter to Senator John Thune (R-SD) and Senator Bill Nelson (D-FL) urging inclusion of a provision that would allow states to regulate air ambulances to provide greater clarity and certainty to this increasingly complex and expensive health care service.
Aug 6, 2018
CMS Administrator Floats Ending Incentives for Medicare ACOs that Don't Take Downside Risk
On Monday, at an American Hospital Association meeting CMS Administrator Seema Verma suggested that the days of Medicare ACOs not taking financial downside risk are coming to an end.
May 11, 2018
New Head of Center for Medicaid and Medicare Innovation (CMMI) Brings Private Sector Expertise
Earlier this month, CMS Administrator Seema Verma announced Adam Boehler as the new head of CMMI, the agency that develops and tests innovative payment and delivery models for the Medicare program. Mr. Boehler brings private sector expertise with health care startups, venture capital firms and home health agencies.
Apr 13, 2018
Working for You in Washington – April 3, 2018
Working for You in Washington – April 3, 2018
Apr 3, 2018
Governors Author Bipartisan State Health Reform Blueprint
A handful of governors from both parties issue outline for health coverage expansion as well as payment and delivery reform and provider consolidation.
Mar 5, 2018
New Spending Deal Kills Medicare Payment Advisory Board and Speeds Up Relief to Seniors for Out-of-Pocket Drug Costs
Last Friday, Congress passed and President Trump signed the Bipartisan Budget Act of 2018 which funds the federal government through March 23. The law also eliminates the ACA-created Medicare Independent Payment Advisory Board and closes the donut hole in 2019.
Feb 14, 2018
NBGH Working for You in Washington
Details of NBGH Advocacy activity in the last month to advance employers' health policy agenda
Dec 19, 2017
2017 Response to CMS's Request for Information (RFI) for the Center for Medicare and Medicaid Innovation (CMMI)
The Business Group supports CMS's efforts to prioritize the goal of fostering an affordable, accessible healthcare system that puts patients first. We also strongly encourage the agency to stay the course on initiatives that are working well to reduce costs while improving quality, particularly alternative payment and delivery models. Open the letter for comprehensive policy recommendations.
Nov 20, 2017
Working for You in Washington – November 3, 2017
The Business Group's public policy team's recent policy initiatives include: pushing to eliminate the ACA's excise tax, separating preventive services policy from benefit mandates, simplifying ACA reporting requirements for employers, improvements to wellness rules, advancing pay-for-performance and alternative payment models and value payments in Medicare.
Nov 3, 2017
Vermont Shifts From Coverage Reform to Payment and Delivery Reform
Vermont is seeking to transform health care delivery and transition to value-based payment models for population health management, with a goal of limiting health spending growth to 3.5%.
Sep 29, 2017
Employers' Current Strategy Around ACOs
This Numbers You Need chart highlights data on whether employers' current strategies include ACOs. For more information on this chart, please see the National Business Group on Health's 2019 Large Employers' Health Care Strategy and Plan Design Survey.
Sep 12, 2017
Comments to CMS Administrator Seema Verma on 2018 Proposed Updates to the Medicare Physician Fee Schedule Supporting Site-Neutral Payments, Reducing Providers' Reporting Burdens and Other Recommendations
The National Business Group on Health submitted comments on the 2018 proposed rule (CMS-1676-P) to update the Medicare Physician Fee Schedule supporting neutralizing payment rates for same services at different health care sites, reducing reporting burden on providers, as well as focusing on the nation's opioid and behavioral health epidemics.
Sep 11, 2017
Comments to CMS on a Proposed Rule to Modify the Quality Payment Program in Year 2 Supporting Continued Refinement of Payment Systems that Improve Care Quality
The National Business Group on Health submitted comments to The Centers for Medicare & Medicaid Services (CMS) on changes to Year 2 of the Quality Payment Program (QPP), originally implemented as part of the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA).
Aug 21, 2017
Reaching a Tipping Point: Key Elements Necessary for ACO Success
This infographic contains data and information to help employers assess which ACOs are market-ready.
Jul 10, 2017
NBGH Comments to CMS on Proposed Rule for Medicare Hospital Inpatient Payment for 2018
NBGH submitted comments to support expansion of performance-based payment in Medicare and refinements to quality measurement and other improvements in Medicare.
Jun 19, 2017
Employer Checklist: Questions for ACO Consideration
This checklist is a tool to help employers assess whether an ACO strategy is right for their company.
Apr 18, 2017
ACO Journey Map Scoring Guide
The ACO Journey Map is a tool to help employers assess an accountable care organization's (ACO) capabilities along a maturity path. It provides employers with a framework to prompt conversations with health plans and ACO providers, and to inform employer decision-making about an ACO strategy. The following scoring guide contains instructions and detailed definitions of each competency in the ACO Journey Map.
Mar 24, 2017
ACOs Explained
What is an ACO? This two-page primer gives you the basics on what an ACO is, how it differs from past network strategies, it's impact on employers already, and prospects for cost reduction and quality improvement going forward.
Mar 24, 2017
How Lowe's Uses Advanced Analytics to Build Successful COEs
In this webinar, hear how Lowe’s uses advanced analytics to provide their employees and their dependents with access to high-quality, high-value services through well-managed centers of excellence (COEs).
Mar 14, 2017
Studies Suggest That ACOs Could Save Money
Two recent studies suggested that Medicare and Medicaid ACOs could save government funds compared to fee-for-service but they need more time to demonstrate value.
Feb 16, 2017
National Business Group on Health's Position Statement on Accountable Care Organizations (ACOs)
The National Business Group on Health believes that effective Accountable Care Organizations (ACOs) must improve the quality and efficiency of care while not unduly raising prices for any patients or payers in their communities.
Oct 7, 2016
How Employers Can Accelerate Paying for Value in Health Care
The Health Care Payment Learning and Action Network (HCPLAN) is an unprecedented collaboration of private, public, and non-profit sectors whose goal is to transform the nation’s health system by supporting health care value over volume. Both employers and their employees can benefit from improved care and reduced costs, but are more likely to see improvements if they join this initiative and play an active role in shaping the journey toward value-based care.
Oct 6, 2016
CMS Bows to Provider Pressure to Delay Performance Penalties
Recently, CMS, facing pressure from the provider community, proposed to allow providers to choose the extent to which they report quality performance data in 2017 to comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Sep 22, 2016
Comments to CMS Administrator Supporting Proposed Changes to Medicare Hospital Outpatient Reimbursements that Would Continue the Transition from Fee-for-Service towards Payment Models that Command Value and Efficiency
The National Business Group on Health sent a letter to Acting CMS Administrator Andy Slavitt supporting implementing site-neutral payments, removing pain management from dimension of the HCAHPS survey, and more.
Sep 6, 2016
House Passes Bill that Would Allow More Hospital-Owned Facilities to Charge Medicare More than Other Sites of Care for the Same Outpatient Services
Recently, the House passed a bill that would allow planned off-campus hospital outpatient departments (mid-build HOPDs) to continue to charge Medicare more for the same services delivered at other sites of care.
Jun 17, 2016
Letter to House Speaker Ryan Opposing Legislation that Would Weaken Medicare Site-Neutral Payments
In response to recently-passed legislation (H.R. 5273), the Business Group sent a letter to House Speaker Paul Ryan expressing concerns about exempting mid-build off-campus hospital outpatient departments (HOPD) from the site-neutral payment requirement in Section 603 of the Bipartisan Budget Act of 2015.
Jun 13, 2016
Emerging Payment and Delivery Models- The Primary Care Physician's Perspective
During this webinar, results from the NBGH- Fidelity Investments Survey of Primary Care Physicians were presented. Topics included awareness , participation and perspectives of alternative payment models.
Apr 20, 2016
8 Tips for Communicating with Employees about ACOs, PCMHs and Other Delivery System Changes
Employers, by using effective communication strategies, are well-positioned to educate and motivate their employee members to take advantage of delivery system improvements, and also direct them to more efficient health care providers. This Employer Guide provides recommendations for communicating payment and delivery reforms to employees.
Apr 13, 2016
New Evidence Shows Importance of Investment in Patient-Centered Medical Homes
This webinar gives an overview of the Business Group's document on new evidence showing the importance of investing in a value-based primary care strategy, incorporating high-functioning patient-centered medical homes (PCMHs). The slides give an overview of the PCMH model, review new evidence showing significant positive outcomes, address employer concerns, and provide recommendations for benefit managers.
Mar 22, 2016
Questions for Employers to Ask Health Plans When Considering a PCMH Strategy
This Checklist is designed to help employers consider opportunities for investing in patient-centered medical homes (PCMH) in partnership with their health plans. New evidence shows PCMHs consistently achieving reductions in unnecessary utilization and costs.
Mar 21, 2016
The Primary Care Imperative: New Evidence Shows Importance of Investment in Patient-Centered Medical Homes (PCMH)
Patient-centered medical homes (PCMH) seek to equip primary care providers with tools necessary to provide higher quality care, with financial incentives to control costs at the same time. Employers have reasonable doubts about delivery system reforms, but new evidence shows clear and convincing positive results from the vast majority of PCMH practices. This issue brief gives an overview of the PCMH model, reviews the exciting evidence, addresses common employer concerns, and provides employer recommendations.
Mar 16, 2016
Primary Care Physicians' (PCP) Embrace of Alternative Payment Models
This Numbers You Need chart contains data on primary care physicians' current adoption of alternative payment models, as well as their willingness to participate in the future.
Mar 8, 2016
Emerging Payment and Delivery Models – The Primary Care Physician’s Perspective
This joint survey between the National Business Group on Health and Fidelity Investments looks at the perspectives of 500 primary care physicians concerning payment and delivery reform, such as pay-for-performance (P4P), primary care medical homes (PCMHs) and accountable care organizations (ACOs). The findings highlight what could be done to improve efficiency and drive optimal outcomes.
Mar 4, 2016
Emerging Payment and Delivery Models – The Primary Care Physician’s Perspective: Infographic
This infographic highlights results from the joint survey between the National Business Group on Health and Fidelity Investments which looked at primary care physicians' views on payment and delivery reform.
Mar 4, 2016
Letter to House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Health Subcommittee Chairman Joseph Pitts (R-PA) Supporting Eliminating Medicare Disparities in Site-of-Service Reimbursement Rates
The National Business Group on Health submitted a letter to House Energy and Commerce Committee Chairman Upton and Health Subcommittee Chairman Pitts recommending that Congress keep Section 603 of the Bipartisan Budget Act of 2015 intact. The provision would align provider reimbursement rates for same services performed at provider-based, off-campus hospital outpatient departments (HOPD) with those typically reimbursed under applicable existing fee schedules.
Feb 19, 2016
Comments to the Centers for Medicare and Medicaid Services (CMS) on the 2016 Proposed Rule for the Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals
The National Business Group on Health submitted comments to the Centers for Medicare and Medicaid Services’ (CMS) supporting their proposed Hospital Inpatient Prospective Payment Systems (IPPS) changes for acute care hospitals for 2016.
Jun 16, 2015
Employer Perspectives On Accountable Care: ACO Definitions, Key Considerations, and Recommendations
This issue brief lays out definitions of accountable care organizations (ACOs), key questions employers should consider when looking at investing in an ACO strategy, and an overview of employer perspectives and concerns related to ACOs. This publication was created in collaboration with Leavitt Partners and the Robert Wood Johnson Foundation. More info at leavittpartners.com/impact-of-accountable-care
May 12, 2015
Joint Letter to the CMS Administrator Recommending No Future Cuts to Medicare Advantage Program
The National Business Group on Health and other employer organizations sent a letter to the CMS Administrator reconsideration of any further cuts to the Medicare Advantage (MA) program that harm retiree health benefits for millions under MA Employer Group Waiver Plans (MA-EGWPs) during the upcoming 2016 rate setting process.
Feb 18, 2015
Comments to the CMS Administrator on the Medicare Shared Savings Program for Accountable Care Organizations (ACOs)
The National Business Group on Health sent comments to CMS on a proposed rule for Accountable Care Organizations supporting a new ACO track 3, bonuses for quality, regulatory relief from Medicare rules, prospective assignment of beneficiaries and more downside risk. However, the Business Group did not support extending the ability for Track 1 ACOs, which share no downside risk, to stay in Track 1 for an additional three years.
Feb 6, 2015
HHS Sets Timeline to Transition from FFS
By 2019, HHS intends to pay 50% of FFS payments through its alternative payment models and tie 90% of FFS hospital payments to quality or value.
Feb 5, 2015
Summary of Health Care Provider Payment Reform Models
This document provides an overview of six provider payment reforms, including non-payment for adverse outcomes, pay-for-performance, accountable care organizations (ACOs), bundled payments, capitated payments, and reference-based pricing.
Feb 2, 2015
National Business Group on Health's Position Statement on Medicare Advantage
The National Business Group on Health strongly supports a stable and successful Medicare Advantage program.
Sep 22, 2014
National Business Group on Health's Position Statement on Medicare Pay-for-Value
Federal and State Government health programs, employers, and health plans (purchasers) should implement pay-for-value.
Sep 22, 2014
What Your CEO is Reading - Bundled Pricing
The article highlights the potential benefits of bundled pricing, including promoting high-quality, efficient care; reducing unnecessary care; and improving the predictability of health care costs for certain procedures.
Jun 10, 2014
Just the Facts: Health Plan Innovations
The National Business Group on Health surveyed the five largest health plans in the country to determine their use of innovations in payment and delivery reform, including the use of accountable care organizations (ACOs) centers of excellence (COEs), telemedicine, shared and bundled payments.
May 9, 2014
Employer Checklist for Accountable Care Organizations (ACOs)
To assist our members with selecting and contracting with ACOs, the Business Group and our 2012 - 2013 David Scherb Executive Health Policy Fellow (Greg Marchand, Director, Benefits Policy and Strategy, The Boeing Company) developed a ACO checklist of criteria that employers should consider in negotiations.
May 8, 2013
Employer Request for Proposal (RFP) Questions for Accountable Care Organizations (ACOs)
To assist our members with selecting and contracting with ACOs, the Business Group and our David Scherb 2012 - 2013 Executive Health Policy Fellow (Gregory D. Marchand, Director, Benefits Policy and Strategy, The Boeing Company) developed a detailed list of questions for ACOs that employers should consider when requesting RFPs from potential ACOs as potential partners.
May 8, 2013
Centers for Medicare and Medicaid Services' (CMS) Final Rule Paves the Way for Release of Medicare Claims Data
CMS released a final rule on Medicare claims data sharing that allows qualified entities (employers, data warehouses/integrators, insurers, nonprofit organizations, consumer groups, etc.) to combine Medicare claims data with commercial claims data to evaluate physicians' efficiency and measure their performance on specific quality measures at the individual physician, physician group, or integrated delivery system levels.
Dec 12, 2011
CMS Adds to Never Events Policy, Will Stop Paying for Three "Never Events"
Centers for Medicare & Medicaid Services issued three National Coverage Determinations (NCDs) to protect patients from preventable surgical errors.
Jan 22, 2009

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