Healthcare today remains a complex maze for too many individuals, with fragmented, duplicative, and inefficient care frustrating patients and providers alike. But as we move into a post-election landscape, the potential for transformative health reforms is on the horizon. In this episode, we’re thrilled to feature with Mara McDermott, one of the nation’s leading voices in advancing accountable care.
Mara McDermott is the Chief Executive Officer of Accountable for Health, a Washington D.C.-based advocacy organization committed to accelerating the adoption of effective accountable care. She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment, and payment models.
In this episode, we dive into critical topics shaping the future of healthcare, including the implications of the 2023 MSSP and ACO REACH results, the evolving role of CMMI under a new administration, and the high stakes of Medicare physician payment reform during this lame-duck session.
Podcast Bookmarks
01:30 Introduction to Mara McDermott, Chief Executive Officer of Accountable for Health (A4H)
05:30 Update on how A4H advancing accountable care through stakeholder collaboration and advocacy.
06:30 Critical policy issues that A4H is working on to achieve accountable care at scale.
07:20 Advocacy for ACO REACH continuity, MSSP enhancements, and specialist integration.
08:10 Key Takeaways from MSSP and ACO REACH in PY 2023
10:00 Mara provides a high-level overview of the MSSP and ACO REACH results.
10:30 The $2.1B in MSSP savings is really an undercounting because of the flow-through to MA. (More like $4B.)
11:30 Transformation due to MSSP and ACO REACH is the untold story.
12:00 Capturing transformation stories through case studies (Read the case study on SOFHA from our last podcast episode!)
12:15 Outstanding ACO REACH results due APM design (e.g. two-sided risk, claims payment flexibilities, capitation)
12:45 The importance of ACO REACH continuity once it expires in 2026. (A4H is advocating for an extension pathway.)
13:15 “These models are delivering better health outcomes and quality, at a lower cost for the federal government and beneficiaries.”
14:00 Key health policy provisions in the lame-duck session (e.g. telehealth flexibilities, extending APM bonuses, physician payment)
15:30 Potential lame-duck package to mitigate Medicare physician fee cuts and extend the APM bonus incentive.
16:30 Longer-term structural reforms to physician payment.
16:45 “MACRA 1.0 that created bonuses for advanced APMs has moved the needle.”
17:45 A4H is advocating for a flat APM bonus based on attribution (versus percent of claims).
18:30 Proposed additional advanced APM participation opportunities (e.g. extending ACO REACH, full-risk MSSP track).
19:45 How will President-Elect Trump’s administration influence the trajectory of accountable care?
20:15 Early indications suggest strong focus on MA and risk-based models and private-sector innovations.
22:30 The first Trump administration’s strong focus on two-sided risk. (“I see a doubling down on those goals.”)
23:30 Revisiting the Geographic Direct Contracting Model (“Geo”) introduced in Trump 1.0.
23:45 No indication as of now that Transforming Episode Accountability Model (TEAM) will be rescinded.
24:10 Potential return of drug pricing models (e.g. international price index, most-favored-nations).
24:20 “I am optimistic on the acceleration of accountable care…”
25:00 New administration to be focused on patient choice and combating chronic disease.
25:45 Will President Trump’s win further accelerate the privatization of Medicare?
28:15 The explosive growth trajectory of Medicare Advantage (MA) and a new openness to support it budgetarily.
29:30 The phenomenal use cases for accountable care in MA.
30:00 “I personally don’t think Traditional Medicare totally fades into the background…”
30:30 Referencing the Paragon Health Institute’s recommendations on MA payment policy.
31:30 What will be the impact of private sector-driven innovation on health equity?
34:00 The Kidney Care Choices (KCC) model as an example of accountable care innovation.
35:00 Amazing results from the High Needs Track of ACO REACH in managing patient with complex care needs.
35:45 Optimism for specifically targeted APMs to improve health equity.
38:45 Is determining ACO beneficiary attribution on the plurality of primary care services the right policy choice?
40:00 The dramatic consequences of excluding beneficiary voices in Accountable Care advocacy.
40:30 Voices of Accountable Care – incorporating the voices of the individuals, families, and caregivers in health policy.
41:30 Reframing our language – moving away from “value-based care” towards “accountable care” or “patient-first.”
45:00 A potential inflection point with AI in advancing accountable care while lowering clinician burden?
48:30 The longstanding history of accountable care being a sustained bipartisan commitment.
49:00 Parting thoughts on how industry leaders can engage in health policy advocacy.
50:30 Information on the upcoming Health Care Value Week and how to stay connected with A4H!