AMGA Ready To Work With Congress And To Lead Transition To Value-Based Health Care

Recently AMGA detailed its legislative agenda to the 115th Congress in a letter that emphasized the importance of continuing the shift to value-driven reimbursement in health care. The new Congress offers an opportunity for lawmakers to address a number of important issues in creating a pathway to value in health care. AMGA and its membership of 450 multispecialty medical groups and integrated delivery systems are prepared to be a resource to Congress as it addresses these priorities.

“It is very clear that policymakers want to transform how health care is financed and provided,” said Donald W. Fisher, Ph.D., CAE, AMGA’s president and chief executive officer. “Our priorities are based on the need to address the obstacles that are preventing providers from succeeding in a risk-based system that values and rewards quality instead of the volume of services provided.”

Fisher continued, “Access to standardized claims data is of vital importance to providers. Without it, providers cannot reasonably care for and improve the health of a patient population.”

AMGA’s letter specifically notes several key improvements that need to be made to fulfill the broader goal of a value-based healthcare system:

• Access to claims data: Federal and commercial payers must provide access to all administrative claims data to healthcare providers so they can manage a patient population.
• Standardization of data: Absent a standard data submission and reporting process for all federal and commercial payers, providers face a needless administrative burden in reporting data.
• Access to capital: Providers should be permitted to use income on a tax-free basis to invest in the infrastructure necessary to take on downside risk.

The letter also details key improvements that should be made to help ensure a successful implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its new payment system, for which AMGA members have been diligently preparing:

• Medicare Advantage revenue should be considered in payment year 2019 for Advanced Alternative Payment Model (APM) purposes to provide greater opportunity to participate in these new care arrangements, which have the potential to improve population health.
• The financial risk thresholds for Advanced APM status need to be adjusted to account for the possible lack of commercial risk products in local markets.
• The significant investments that Track 1 Accountable Care Organizations make in information technology and care process redesign should qualify them for Advanced APM status.

In addition, AMGA emphasized to Congress how vital the in-office ancillary services (IOAS) exception within the Stark physician self-referral law is to multispecialty medical groups and integrated healthcare delivery systems.

The letter also stressed the importance of preserving Medicare Advantage, ensuring appropriate healthcare coverage, and strengthening graduate medical education.

About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of medical groups’ recognized excellence in the delivery of coordinated, high-quality, cost-effective care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, visit amga.org.