CMS' 2030 Value-Based Care Goal at 'Inflection Point'

Modern Healthcare / By Michael McAuliff
 
The Biden administration's goal to move all Medicare beneficiaries into accountable care arrangements by 2030 may be just within reach, but is at a turning point.
 
The most immediate question that could determine the initiative's future is whether Congress extends a bonus program meant to help providers transition away from fee-for-service reimbursement and toward value-based payment before it expires this winter.
 
But longer-term issues have risen to the fore, such as how success is measured and rewarded, and both Congress and the Centers for Medicare and Medicaid Services will have to make adjustments to reach the final goal within five years, industry sources and analysts contended.
 
"We are at an inflection point of having to rethink this approach of how we set benchmarks and define what level of savings can be achieved in a model," said Aisha Pittman, senior vice president of government affairs at the National Association of Accountable Care Organizations.
 
TRACKING LAYOFFS & CLOSURES
 
CMS set its goal not long after President Joe Biden took office in 2021, when about 10.7 million people got their care from Medicare Shared Savings Program ACOs, according to the Medicare Payment Advisory Commission.
 
The shared savings population sat at 10.8 million when this year began. Overall, 24% of Medicare beneficiaries were in an accountable care arrangement, while 22% were in traditional fee-for-service, and the rest were in Medicare Advantage. All told, 13.7 million Medicare enrollees were in some sort of accountable care arrangement, CMS announced in January.
 
Over the same span, the number of ACOs has stayed about the same, rising from 477 in 2021 to 482 this year.
 
"We're kind of in an awkward adolescence, in many ways, with value-based payment," said Rob Saunders, senior research director at the Duke University Margolis Institute for Health Policy.
 
Whether or not the push value-based care from the Center for Medicare and Medicaid Innovation, which runs the campaign, has been successful depends who you ask and what metrics they use.
 
For instance, dissatisfaction with CMMI has grown on Capitol Hill, where skeptical lawmakers regularly point to an analysis the Congressional Budget Office published in September 2023, which found the innovation center had tested 49 models yet only approved five expansions, all while raising spending by $5.4 billion instead of saving money.
 
Still, non-political observers say there are good reasons for what looks at first glance like a high rate of spending and failure: The innovation center is testing out many new ideas, just as Congress and President Barack Obama tasked it do under the Affordable Care Act of 2010…

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The Quiet, Transformative Power of Introverted Leaders

Forbes / Benjamin Laker , Contributor

When workplaces celebrate loud voices, charismatic personalities, and the “move fast, break things” attitude of leadership, introverts may seem out of place. Leadership, we’re told, belongs to the extroverts—the ones who command rooms, deliver inspiring speeches, and thrive in the spotlight. But what if we’ve been overlooking a quieter form of leadership all along?

Introverted leaders are often the unsung heroes of organizations, possessing a unique power that’s grounded in thoughtfulness, empathy, and a deep understanding of their team. The truth is, the quiet power of introverted leaders is not just an alternative leadership style—it’s a vital force for creating sustainable success.

The Misconception of Leadership

Leadership, for decades, has been conflated with extroversion. The loudest voices in the room are often assumed to be the most capable, and those who thrive in social situations are seen as natural leaders. This misconception has shaped our understanding of leadership as a public performance—a series of bold decisions, grand gestures, and public displays of confidence.

But this narrow view of leadership ignores the quiet strengths that introverts bring to the table. Introverted leaders may not be the ones dominating the conversation, but they are often the ones listening, analyzing, and thinking deeply before they act. Their approach is slower, more deliberate, and often more thoughtful, which can lead to better decision-making and a more cohesive team.

Introverts excel in environments where deep thinking and reflection are required. Their preference for listening rather than speaking allows them to take in more perspectives, fostering a culture of collaboration and respect. They don’t need to be the center of attention to be effective, and their quieter approach often leads to more thoughtful, strategic leadership…

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New Workforce Legislation Introduced in Congress

NAHC Report

October 10, 2024

In a step towards addressing the growing workforce shortage in home care, new legislation has been introduced in Congress aimed at alleviating shortages that have left many vulnerable populations without care. This issue has become increasingly critical as the demand for home care services grows with an aging population and the desire for seniors to age in place.

The proposed legislation focuses on several key areas, including increasing funding for home care services, enhancing training programs for caregivers, and providing incentives for professionals to enter and remain in the field. These measures are designed to not only improve the working conditions and compensation for home care workers but also to ensure a stable and skilled workforce that can meet the needs of patients.

Three of the new bills are being led by Senators Angus King (I-ME) and Bob Casey (D-PA), brief summaries of each follow:

The Direct Support Worker Training Reimbursement Act would:

• Provide enhanced federal matching payments for direct support worker training programs at a 75 percent rate.

The Mollie Baldwin Upskilling of Personal and Home Case Aides Act would

• Create funding through the Health Resources and Services Administration (HRSA) for demonstration projects to provide individuals already working in the home care workforce with opportunities for education, training and career advancement.

The Career Advancement for Direct Support Aid Workers (CADSAW) Act would:

• Create funding through HRSA to help individuals already working within the home health care field with opportunities to pursue increased education and training to facilitate career advancement.

The fourth new bill, the Health Care Workforce Investment Act led by Representatives James Comer (R-KY) and Morgan McGarvey (D-KY) would:

• provide grants to states that create public-private partnerships to increase participation in educational, credentialing, or licensing programs.

These new bills have been introduced but have not received any further consideration from their respective chambers. The National Alliance for Care at Home will continue to track developments when the Congress returns to session following the elections in November 2024.

‘A Deteriorating Industry’: What Home Health Provider Margins Actually Look Like

Home Health Care News / By Andrew Donlan
 
The Medicare Payment Advisory Commission (MedPAC) paints a rosy portrait of home health margins. But an analysis of cost reporting data – that considers both traditional Medicare and Medicare Advantage (MA) payments – shows that providers are generally not sitting atop a hill of money. Instead, they are struggling to stay above water. 
 
Kalon Mitchell sold his company to the post-acute technology organization WellSky in 2018. He then worked for WellSky for five more years, learning the ins and outs of the home health industry in the meantime. 
 
After leaving WellSky, and with some more time on his hands, Mitchell decided to start “Project Sword”, which leverages cost reporting data to analyze the financial position of home health providers at large. 
 
The data shows not an industry enjoying close to 20% margins, but instead one that is in a deeply precarious position moving forward. 
 
The Centers for Medicare & Medicaid Services (CMS) has proposed cuts to home health payments three years in a row. Though its last two final payment rules have not been as harsh as its proposals, they have still come with permanent cuts to payments. 
 
Providers have multiple gripes with these cuts. The first is over the payment methodology that CMS applies, which most providers and advocates strongly disagree with. The second is the rising costs that home health agencies have recently faced. While CMS is cutting home health payment in traditional Medicare, the cost of providing services has skyrocketed – namely due to the cost of labor. 
 
But the final gripe is the one that has turned into a “generational battle” for providers, and that is MA penetration and payment. 
 
Over 50% of Medicare beneficiaries are now under an MA plan, and those plans generally pay far less for home health care than traditional Medicare. 
 
Providers have regularly told Home Health Care News that MA payment for home health services doesn’t cover the cost of delivering care. But providers tend to be mission driven, and also have referral relationships to uphold. Therefore, they continue to take on MA patients, which sinks their overall margins. 
 
Essentially, traditional Medicare subsidizes MA plans in home health care. It’s true that if providers only took traditional Medicare, they would likely enjoy healthy margins. On the other end, though, if they only took MA, they’d likely have inoperable businesses. 
While providers have shared these MA payment horror stories anecdotally, it’s been hard to get a good overall picture of what the average home health provider’s margin looks like of late – as both MA penetration and traditional Medicare rate cuts continue unabated…

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