Medicare's Fee for Service Alternative Payment Models (APMs), a creation of 2015 MACRA legislation, currently 12 in number with participation largely voluntary, requires Medicare providers to assume financial risk, based on historical spending and quality measurement performance, beyond a "nominal amount." The flagship APM is the ACA's Medicare Shared Savings Program, more commonly termed Accountable Care Organizations (ACOs). Though in its 8th year, the ACO program, that currently provides care to over 10 million assigned Medicare beneficiaries, has not produced meaningful savings (estimates are 1 to 2% annually). Nor have other APMs, largely bundled payment arrangements, produced substantial savings. The Medicare Advantage program (with one-third of Medicare beneficiaries), defined as administrative pricing, does not formally score savings. Over the past few years per capita Medicare spending has been limited, however, program growth or beneficiary enrollment (via the aging baby boomer population) is causing Medicare spending, in sum, to increase substantially. In addition, the soon-to-be-published annual Medicare Trustee's report will show the program will become insolvent within the next few years.
During this 26 minute discussion, Mr. Miller provides an overall assessment of APM performance to date. He moreover discusses the shortcomings in APM design or the barriers APM providers face in improving care, e.g., as ostensibly Fee for Service APMs are not reimburse for valuable non-medical services such as social service supports and ways to improve these models. We conclude the discussion with his views on the ACA-created PTAC (the Physician-Focused Payment Model Technical Advisory Committee), that has reviewed to date over 30 submitted APM proposals, none of which have been chosen by Secretary Azar for testing as a Medicare demonstration.
Mr. Harold D. Miller is the President and CEO of the Center for Healthcare Quality and Payment Reform. In this role he has worked in more than 40 states and metropolitan regions to help physicians, hospitals, employers, health plans, and government agencies design and implement payment and delivery system reforms. He is also currently one of eleven members of the PTAC. He also serves as Adjunct Professor of Public Policy and Management at Carnegie Mellon University. Mr. Miller has written a number of widely-used papers and reports on health care payment and delivery reform. He has assisted numerous professional organizations in developing alternative payment models designed to support better care for patients at lower cost. From 2008 to 2013, Mr Miller served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), the national association of Regional Health Improvement collaboratives. He served as a member of the Board of Directors of the National Quality Forum from 2009 to 2015. From 2006 to 2010, Mr. Miller served as the Strategic Initiatives Consultant to the Pittsburgh Regional Health Initiative (PRHI). In 2007, he served as the Facilitator for the Minnesota Health Care Transformation Task Force. In previous positions, Mr. Miller served as the Director of the Pennsylvania Governors Office of Policy Development, Associate Dean of the Heinz School of Public Policy and Management at Carnegie Mellon University, Executive Director of the Pennsylvania Economy League - Western Division, Director of the Southwestern Pennsylvania Growth Alliance and President of the Allegheny Conference on Community Development.
For information on the Center for Healthcare Quality and Payment Reform, go to: http://www.chqpr.org/
For information on the PTAC, go to: https://aspe.hhs.gov/ptac-physician-focused-payment-model-technical-advisory-committee
Per my mention of Dr. Robert Berenson's recent (February) essay concerning improving the Medicare Fee for Service schedule, go to: https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05411