Ep 100 – The Long Road to Health Care Transformation: Aligning the Public and Private Sector in Value, with Jeff Micklos

Jeff Micklos is the Executive Director of the Health Care Transformation Task Force, an industry consortium that brings together patients, payers, providers and purchasers to align private and public sector efforts to clear the way for a sweeping value transformation of the U.S. health care system. Under Jeff’s leadership, the Task Force provides a critical mass of business, operational and policy expertise from the private sector that, when combined with the efforts of the Centers for Medicare & Medicaid Services and other public and private sector stakeholders, can accelerate the pace of delivery system transformation.

Jeff is a great ally in this Race to Value, and the Task Force is doing its part to catalyze value-based payment adoption.  In January 2015, the task force was formed based on a commitment to the triple objective of better care, better health and lower costs. As a unique private sector coalition under Jeff’s executive leadership, the task force has an unrelenting vision to accelerate the pace of value-based care transformation.  Consequently, they have set the goal for payer and provider members in the Task Force to have 75% of their business in value-based payment arrangements by the end of 2025.

Listen to this episode to learn everything you need to know about the health policy landscape, strategic implications for payment and delivery transformation, and how redesigned payment models will help us seek sustainable improvements in health equity, patient outcomes, and consumer experience.

Episode Bookmarks:

01:40 Introduction to Jeff Micklos and the Health Care Transformation Task Force

03:30 The grim stats on the U.S. health system and the need to accelerate value-based care transformation

05:00 Change is hard. And change is even more difficult when the status quo is so lucrative in fee-for-service medicine.”

05:30 30% of fee-for-service healthcare is related to low-value care (changing this is a major opportunity to sustain in the long-term!)

05:45 Changes to payment models and the market-driving force of Medicare reforms in healthcare transformation

06:00 HCTTF Transformation Goal: 75% of members operating under value-based payment arrangements by 2025 (progress made by reaching 61% in 2020)

06:55 CMS Innovation Center (CMMI) Strategy Refresh Target Goal:  All Medicare FFS beneficiaries in a accountable care relationship by 2030

07:15 A financial spend metric (in and of itself) is not an indicator of success in value transformation.” (qualitative measures just as important!)

08:20 COVID-19 has only emphasized the need for significant payment and delivery transformation

09:30 The uncertain political climate and how that is shaping current delivery system reform efforts and private sector momentum for value-based transformation

10:00 Extension of the MACRA 5-percent Advanced APM incentive payment (currently scheduled to sunset in 2024)

11:00 The Build Back Better Act and its potential impact on improving health care and lowering costs

11:30 Increased coverage in the ACA marketplace exchanges as a success of the Biden Administration

11:50 The impact of the Russia-Ukraine situation on advancing health policy objectives in the near term

12:00 The upcoming midterm election and how the projected electorate change towards full GOP control may shift the political dynamics of the value movement

12:45 The CMMI Strategy Refresh as a guidepost for the future direction of the value movement

15:00 Reflecting back on the 1st 10 years of the CMS Innovation Center and lessons learned from theMedicare Shared Savings Program (MSSP)

15:50 ACOs overall have played a key role in transforming the health care system by creating incentives for providers to deliver high quality, cost efficient care.”

16:10 Leveraging MSSP as a platform to scale provider adoption of other APMs

16:45 The failure to reach rural areas with APMs and the need for continued investment initiatives like the ACO Investment Model (AIM)

17:20 Next Generation ACO Model has increased appetite of advanced providers for new full risk track in the MSSP

18:00 MedPAC recommendations that CMS streamline the CMMI APM portfolio by using MSSP as a platform for model testing

18:30 The need for predictable and sustained provider participation in the MSSP to advance the value movement

19:00 Payment model evaluation studies to overcome challenges with accurate counterfactuals, spillover effects with other APMs, minimum attribution, etc.

20:00 The challenges of translating model evaluation findings into broader policy actions

21:30 The stringent process of certifying payment models to justify APM expansion

23:30 CMS has tested over 50 models and only expanded 5 of them at this point

24:20 Recent HCTTF recommendations to CMMI for improving model evaluations and certification

26:00 How ACO overlap with bundled payment models is working against scalable value transformation

27:20 The need for increased specialist integration to further align and improve coordination with primary care

30:00 Medicare Advantage (MA) as an effective driver of value transformation and consumer-centric innovation

32:00 The flexibility inherent in the MA platform is allowing us to move clinical care transformation forward more expeditiously than traditional Medicare.”

33:00 The growth in MA enrollment and how it has doubled in market penetration over the last 14 years (from 10 million in 2008 to 28 million in 2021)

34:00 MA flexibility in benefit design allows for better service to beneficiaries in meeting unmet needs

35:00 MA plans are able to pass savings to beneficiaries (e.g. 83% of MA plans offer $0 monthly premiums)

35:30 Other aspects of MA as a effective value driver (e.g. full capitation, quality incentives, benefit design that focuses on preventive services)

36:00 Better outcomes for MA patients (e.g. high cost-high need patients, pneumonia vaccinations, eye exams for diabetics, depression screening rates, PCP office visits)

36:30 The slow rate of driving value in commercially-insured populations

37:20 Task Force Priorities for 2022, including the promotion of Medicare Advantage as an effective driver of value transformation

40:00 The current heated debate in Health Affairs right now between Richard Gilfillan/Don Berwickand George Halvorson

43:00 The recently announced revamp and relaunch of the Direct Contracting (GPDC) model withACO REACH (Links to recent ACLC Brief and Prior R2V Podcast)

45:15 How ACO REACH will improve health equity and access to care through a capitated model

46:45 Lack of capital investment will limit impact of ACO REACH in expanding access to underserved areas

48:00 The application process for ACO REACH

48:45 Addressing inequities through adjustments to ACO REACH benchmarking methodology

49:30 Governance changes to Board representation to ensure stronger physician leadership and consumer engagement

51:00 Uncertainty of increased transition to risk adoption for providers with new ACO REACH model

51:30 Model evaluation and perceived differences between GPDC and ACO REACH

52:30 Referencing recent study denoting lack of consumer engagement in value-based care

53:45 The leadership of Task Force Founding Chair Rick Gilfillan in addressing lack of consumer engagement

55:00 CMS Resources to improve ACO Beneficiary Engagement (recent listening session and toolkit)

56:00 Medicare Advantage marketing guidelines and how it may limit opportunities for patient education

58:40 How consumer feedback from ACO beneficiaries can drive performance improvement in the private sector

61:00 How the Task Force is advancing purchaser and employer engagement to drive value in commercially-insured populations

66:00 The priority of health equity is unassailable” (how ACOs and other risk-bearing entities will advance health equity)

70:00 The lack of self-reported data on race, ethnicity, sexual orientation, gender identity, disability status, and veteran status

71:00 The longer term return horizon on investments in Health Equity reporting infrastructure and SDOH interventions

74:00 Parting thoughts on health care resiliency and current tailwinds for value transformation