HCTTF Letter Offering Congress Recommendations to Support APM Participants

The Health Care Transformation Task Force (HCTTF or Task Force) wrote a letter urging Congress to take bold action to advance value-based payment and care delivery during and after the COVID-19 pandemic.

Providers operating under mature value-based payment models have shown the ability to withstand the pressures associated with COVID-19. Providers operating under capitated or global budget models have not experienced the cash flow disruption that have besieged fee-for-service providers. Advanced population health infrastructure has been leveraged to continue to manage care for patients, particularly those vulnerable or seriously ill patients. It is these positive experiences that should be championed and duplicated to ensure that this system as a whole is on the path to a modern delivery model that provides high quality care at lower cost which results in healthier individuals and communities.

Task Force Recommendations

HCTTF urges Congress to take three actions to bolster the payment incentives that drive providers to engage in Medicare value-based payment models:

  1. Congress should extend the five percent bonus payment for Advanced APMs for five more years. MACRA has not yet driven the desired uptake of alternate payment models, so the availability of financial incentives designed to drive provider uptake of value-based payment models should be extended.
  2. Congress should give CMS the authority to set the thresholds for providers to qualify for bonus payments under the Advanced APM payment policy as defined by MACRA. The current statutory thresholds have already proven to be too high and difficult to meet and will increase from 50 to 75 percent in the 2021 performance year. Providing CMS the authority to set these thresholds will allow for more realistic thresholds that can be differentiated depending on the characteristics of particular value-based payment models.
  3. Congress should direct CMS to waive payment and patient count thresholds and deem all entities participating in eligible Advanced APMs to have satisfied Qualifying APM Provider (QP) thresholds for 2020 performance. HCTTF appreciates that CMS has taken steps to extend leniency for clinicians eligible for MIPS in response to COVID-19. Similar leniency should also be applied to Advanced APM participants.


Read the Letter