This newsletter will be sent out every other month to bring you the latest news from the front lines of the health care value movement and our work to rein in health care industry abuses and reorient economic incentives to ensure affordable, quality, equitable care and health for all.
We'd love to hear from you! Please reach out if you have any news to share for our next issue.
Upcoming Events
Families USA’s 2023 Health Action Conference is dedicated to the communities using their power to make real change. We welcome health care leaders, activists and advocates to our 28th annual conference, held both in-person and virtually from January 26-28. With grassroots movements rising around the country and midterms just behind us, January 2023 is a critical time for advocates to mobilize and collaborate in our shared fight to eliminate health inequities and health system failures. Register here! Final day to register online is Friday, January 20.
News from Congress
Stop Anticompetitive Healthcare Act -Rep. Jayapal and Spartz
U.S. Representatives Victoria Spartz and Pramila Jayapal introduced H.R. 9510, the Stop Anticompetitive Healthcare Act which would give the Federal Trade Commission new authority to enforce antitrust laws on non-profit hospitals. This marks an important step in the work to rein in predatory hospital pricing that is driving unaffordable health care for our nation’s families. Hospital consolidation drives up costs for patients, drives down wages for workers, and has not been shown to improve quality of care.
House Committee Urges GAO to Examine Hospital Price Transparency Compliance -House Energy and Commerce
The House committee on Energy and Commerce is asking the Government Accountability Office (GAO) to look at hospital compliance with the federal hospital price transparency regulation. This is following numerous reports of wide-spread non-compliance. Data suggests that a small majority (55%) of hospitals are beginning to partially comply, and a smaller minority (14%) are determined to be fully compliant with the full scope of the rule.
House Energy and Commerce Chairman and Senate HELP Committee Chair Send Letter of Support of No Surprises Act to HHS Secretary- House Committee on Energy and Commerce, Senate HELP
House Energy and Commerce Chairman Frank Pallone and Senate HELP Committee Chair Patty Murray sent a letter to the tri-agency (Depart of Health and Human Services, Department of Labor, Department of Treasury) secretaries, expressing their strong support for how the agencies have worked to implement the No Surprises Act (NSA). The NSA has faced litigation across the country.
The Latest from the Biden Administration
Primary Care First Model publishes first evaluation report- CMMI
The first evaluation report of the Primary Care First payment model was released on December 6, 2022. Primary Care First is a voluntary five-year payment model that offers an innovative payment structure to support the delivery of advanced primary care, and is based on the principles underlying the existing Comprehensive Primary Care Plus (CPC+) model. The model is operated out of 26 regions and encompasses 3,000 participating practices. The first evaluation report assessed the first year of model implementation and found that payments to primary care providers participating in the model were on average 20% higher than what they would have received under the Medicare physician fee schedule – marking an important investment in primary care. Future reporting will discuss improvements in quality of care, total cost of care, and equity implications.
CMS releases Innovation Center Report to Congress -CMS
CMS released their sixth report to Congress on the status of the CMS Innovation Center (CMMI) as required under statute on a bi-annual basis. The report focused on improvements to the 33 currently-operational models, including those in health care payment and delivery, episode-based care, and accountable care, and reviewed the implementation and evaluation of 5 demonstration projects. The report estimates that 11 million beneficiaries across 483 Medicare Accountable Care Organizations received care through a value-based care program.
Administration for Community Living Announces Selected Participants of the Community Care Hub National Learning Community -ACL
In November, the Administration for Community Living (ACL) and the Centers for Disease Control (CDC) announced a group of 58 organizations participating in the Community Care Hub National Learning Community (NCL). The participating community-based organizations, across 32 states, will coordinate learning, information, technical assistance, and resource sharing with the goal of strengthening their collective preparedness to address health-related social needs. The Hub will serve as a link between payers, providers, and community-based organizations with the goal of increasing person-centered care and health equity efforts nationwide. The NCL will run through the summer of 2023.
Interoperability Proposed Rule- CMS
This proposed rule issued by CMS would place new requirements on Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children’s Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of healthcare data and streamline processes related to prior authorization, while continuing CMS' drive toward interoperability in the healthcare market. Comments are due on March 13, 2023.
FTC Proposed Rule on Non-Competing Clause- Federal Trade Commission (FTC)
In this notice of proposed rulemaking (NPRM) the FTC proposed preventing employers from entering into non-compete clauses with new workers, as well as rescinding existing non-compete clauses with current workers. Non-compete clauses can prevent workers from seeking prospective employment opportunities that may be in competition with their present employer. These clauses can hinder competition by preventing new businesses from forming and potentially hinder innovation. The FTC estimates that implementation of this rule would increase workers’ earnings between $250B and $296B a year.
Medicare Advantage (MA), Medicare Part D Proposed Rule- CMS
This proposed rule would revise regulations, and implement changes, related to Star Ratings, beneficiary protections, health equity, provider directories, coverage criteria, prior authorization, network adequacy, identification of overpayments, and other areas. In the Star Ratings Program, CMS is proposing a health equity index (HEI) reward to encourage MA and Part D plans to improve care for beneficiaries with certain social risk factors. The rule also proposes to clarify current MA requirements on providing culturally competent care. Comments are due on February 13, 2023.
HHS Announces Key Dates for the First Year of the Inflation Reduction Act’s Medicare Drug Price Negotiation Program- CMS
Medicare prescription drug negotiation, under the Inflation Reduction Act, will begin for the first time in 2023. In CMS’s timeline, by September 1, 2023 CMS will have released the first 10 Medicare Part D drugs whose prices are open to negotiation and by September 1, 2024 the negotiated prices for said drugs will be announces. Those prices will not go into effect until January 1, 2026. Between 2027 and 2029 the number of drugs up for negotiation will increase from the original 10 to 20. The negotiations will lower prescription drug prices for millions of Medicare beneficiaries.
State Updates
New Jersey Unions Launch Coalition for Affordable Hospitals to Fight For Fair Hospital Pricing – SEIU 32BJ
The New Jersey Policy Perspective published a report, People Pay, Hospitals Profit, highlighting how high hospital prices financially strain municipal and state budgets and workers' wages. NJ Policy Perspective, AFSCME New Jersey, SEIU 32BJ, and more have come together to launch the New Jersey Coalition for Affordable Hospitals, using the report to call for legislation on fair hospital prices in the state.
SEIU 32BJ NYC and the New York City Reality Board Commission a Report on Hospital Prices -SEIU 32BJ
32BJ has teamed up with the New York City Reality Advisory Board to publish a report on out-of-control hospital prices in the New York City market. The report found high and variable hospital prices throughout the city. The report also found that those high prices were driving down wages for workers. 32BJ is helping support a campaign to reign in these hospital prices. Legislation aimed at protecting patients from large medical bills and medical debt has been signed by the Governor but the campaign continues to push for policy interventions such as restricting anti-competitive contracting for large hospital systems, ensuring that non-profit hospitals behave as non-profits, rate regulation, and global budgets.
Oregon Health Authority report: price increases drove commercial health care costs between 2013-2019; more services provided drove health care costs for Medicaid and Medicare Advantage -OHA
A report by the Oregon Health Authority (OHA) shows significant differences in the drivers of growth of health care costs between 2013 and 2019. Consistent with national trends, the OHA found that the divergence between commercial prices and those paid through Medicare and Medicaid continue to grow, emphasizing the need to address rising commercial prices and overall costs for all Oregon consumers. Acknowledging the differences in these drivers may allow the state to more accurately address rising costs for all Oregon consumers.
Vermont’s Second Evaluation Report for its All-Payer ACO Model published- CMMI
The state of Vermont has been running an All-Payer Accountable Care Organization (ACO) model since January 1, 2017. This alternative payment model aims to increase access to primary care, reduce the prevalence of chronic disease, and reduce deaths due to substance use disorders and suicide. The latest evaluation report spans the first three performance years (2018-2020) and found that the ACO achieved statistically significant reductions in gross spending, totaling $655 per beneficiary per year. Statewide, the model achieved significant gross (6.8%) and net (6.5%) reductions in spending in Medicare Parts A and B. Additionally, ten out of seventeen population health and quality performance measures were fully met at the end of performance year 3.
Health Care Value in the News
Hospital Pricing
Operating Margins Among the Largest For-Profit Health Systems Have Exceeded 2019 Levels for the Majority of the COVID-19 Pandemic - KFF
Hidden audits reveal millions in overcharges by Medicare Advantage plans -National Public Radio (NPR)
Communities of Color Disproportionately Suffer from Medical Debt- Urban Institute
Payment Reform
Value-Based Payment as a Tool to Address Excess U.S. Health Spending- Health Affairs
Surprise Billing
Insurer survey finds surprise billing law shielded 9M claims so far as arbitration popular among providers- Fierce Healthcare
Surprise Medical Billing Disputes Pile Up as Lawsuit Unfolds- Bloomberg Law
Provider Groups Each Bring Third Lawsuit Challenging No Surprises Act- Health Affairs
Price Transparency
Councilmember Julie Menin introduces legislation to oversee inflated hospital prices -AM New York Metro (AMNY)
Watch: A conversation on post-midterm health care policy -Axios
People’s Experience
2022 Healthcare in America Report, America’s Report Card on the U.S. Healthcare System –Gallup, West Health
Families USA Resources
Recent Events
Families USA hosted a webinar for partners to discuss the wins that the health care value movement has had in the past year, and strategize how to reign in hospital costs, with a look ahead to the 118th Congress in 2023. You can watch the recording here.
New Reports
Families USA launched the People First Care initiative to advocate for major reforms to our current distorted health care payment and delivery system. In a series of groundbreaking reports, People First Care will do a deep-dive on various issues contributing to our broken health care system, and share policy recommendations.
The fourth report was published in December 2022:
Do the Right Thing: Shifting Health Care Payment Systems to Value-Based Incentives to Achieve Health Equity and Promote Racial Justice - This paper details how payment reform can transform our health care system into one that facilitates health equity and promotes racial justice. It outlines policy solutions that would make our health care system more affordable, less complicated, and focused on patients.
The fifth report was published in January 2023:
Working Toward True Health Care Payment Reform to Ensure Our Health Care System Serves Families and Patients - This paper unveils the promise of true payment reform, moving away from fee-for-service and volume-based payment systems, in driving toward affordable quality care and improved health for our nation’s families.
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Resources from our Partners
National Association of State Health Policy (NASHP)
Policy Tools to Lower Hospital and Health System Costs
What Can Policymakers Do: Using NASHP’s Hospital Cost Tool 2.0
Coalition Against Surprise Medical Billing (CASMB)
New Polling: Bipartisan Majority of Voters Highly Concerned About Threats to the No Surprises Act
Center for Medicare Advocacy
Provisions of Recently Passed Medicare Drug Bill in Effect Next Month- January 2023
For more information, please contact Mike Persely, Strategic Partnerships Campaign Manager, at [email protected]
