Rep. DelBene: How Congress can help deliver right incentives to providers for value-based care

For Rep. Suzan DelBene, D-Washington, a major proponent of legislation in Congress on value-based care, a key driver is making sure that providers have the tools to succeed in payment models and figuring how Congress can help make that happen.

DelBene is the lead sponsor in the Value in Health Care Act, bipartisan legislation recently reintroduced that intends to get more providers into value-based care payment models. DelBene has also co-sponsored other legislation aimed at improving value-based care in rural areas, including a bill to combat a “rural glitch” that penalizes accountable care organizations in rural areas.

The lawmaker told Fierce Healthcare in an interview that the contours of her district in Washington has helped inform her legislative efforts.

“My district is interesting because it is a combination of urban and suburban areas and rural areas,” she said. “We talked to a lot of ACOs in my state and their feedback has been part of what we took into account [when] writing the legislation.”

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The Value in Health Care Act aims to boost the amount of shared savings that an ACO can get. ACOs agree to take on financial risk and meet quality and spending benchmarks. An ACO that meets those benchmarks gets a share of any savings, but they must repay Medicare if the spending gets above the benchmark.

The legislation is intended to help reverse a slide in participation in ACOs that has occurred over the past several years. Advocacy groups peg the reason for the slide on an effort by the Trump administration to cut the amount of savings and require ACOs to take on financial risk earlier in the Medicare Shared Savings Program.

DelBene said that getting the incentives right was a major factor in the legislation.

“We need to make sure we have fair benchmarks and timelines and incentivize folks as they go through this process moving to value,” she told Fierce Healthcare.

She added that this same approach is needed for another piece of legislation she co-sponsored called the Accountable Care in Rural America Act. The legislation aims to fix an unintended “glitch” that penalizes an ACO when they lower the costs for an entire region.

The Accountable Care in Rural America Act, which DelBene co-sponsored, also aims to correct an issue that unfairly penalizes rural ACOs when they can lower costs for an entire region.

The legislation is also needed for rural hospitals that have been hit hard by the pandemic.

“There have been issues making sure [there is] adequate staffing for our rural hospitals, [personal protective equipment] and access to PPE if you don’t have a big network helping you,” DelBene said.

The pandemic has informed other pieces of legislation DelBene has co-sponsored, including the Seniors’ Chronic Care Management Act that removes cost-sharing for Medicare beneficiaries that get chronic care services.

We need to highlight how important it is that folks have ongoing access to quality and affordable healthcare in all parts of the country,” she said. “Coordinated care is important [and] that gets into the work we are doing on chronic care management.”

The goal is not just to get strong care and cost savings for Medicare but also to give patients a more holistic approach to care, she added.

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It remains unclear whether the legislation can get through Congress, which is now mired in talks over infrastructure.

“Right now, we are trying to see what the Senate is doing,” DelBene said. “The House schedule overall is kind of in flux.”

However, the legislation on value-based care and chronic care has bipartisan support.

“I think that there has to be a huge effort to keep the government funded and pass important legislation to help the country build back better both on infrastructure and small business that has got to be the focus,” she said. “We have work that we will continue to do as we get through these packages too.”