Policy Priorities

Prioritizing physician-led alternative payment models. 

CMS should prioritize a range of physician-led advanced alternative payment models including two-sided, more advanced, higher-gain models calibrated to reflect the financial realities faced by small physician practices. New models should put physician practices at financial risk over time while offering greater reward for taking on that risk. Similar to Track 1+, the risk must be proportional to the finances of independent physician practice and not so large as to favor consolidation of practices. Models should also provide more predictable and accurate benchmarks as in Medicare Advantage.

Creating opportunity for independent practice through a national policy framework that promotes patient choice and provider competition.

The primary care physician-patient relationship is most powerful when there is patient choice and provider competition within local markets. We support legislative and regulatory action that creates parity across practice settings; aligns incentives to enable a range of providers to move toward value-based care; and prohibits anti-competitive behavior such as information blocking.

Enabling physicians to lead the value-based care movement in other markets including Medicare Advantage.

As provider groups gain experience through accountable care organizations and other value-based models, the number of organizations with the necessary skills to manage risk and healthcare within a population will increase. We support new payment models and additional policy flexibility that allows physicians and physician-led groups to take on accountability for  health outcomes and costs in other markets including Medicare Advantage.  Provider groups are best positioned to deploy and experiment with the latest innovations in population health.

Supporting patient-directed care through models that encourage patients to participate in their own healthcare decision-making, and to be rewarded for doing so.

Patient engagement is critical to value-based care. We support models that encourage greater patient involvement in their own healthcare including models that allow patients to identify and align with the primary care physician of their choice; share in savings if their primary care physician participates in a savings model; receive added benefits and/or have their cost sharing reduced or eliminated when engaging in certain behaviors (e.g., high-value preventive services and/or seeking care from high-value providers). The need for patient engagement should, however, be balanced with the need to ensure that independent physicians and practices are not subject to new administrative burdens or paperwork requirements.