Providers push Congress to include value-based care bill in $3.5T infrastructure package

care coordination
Legislation aimed at getting more providers into value-based care could help pay down a $3.5 trillion infrastructure package, a host of provider groups says. (Getty)

As Congress starts drafting a massive $3.5 trillion infrastructure package, a collection of provider groups is making a case for value-based care legislation to be included.

Twelve hospital and physician groups wrote a letter to key House and Senate committee leaders Tuesday asking for the Value in Health Care Act to be included in the package. The legislation, which seeks to boost incentives for providers to participate in payment models, would save nearly $300 million and could be a key selling point to Democrats searching for ways to pay for the package.

“As lawmakers look for offsets or ways to fund the estimated $3.5 trillion new spending in the reconciliation bill, the Value Act provides an avenue to both lower Medicare spending and advance policy to improve our fragmented health system,” said Clif Gaus, president and CEO of the National Association of ACOs, in a statement.

The association commissioned a study from the Moran Company that looked at how much the bill would save the federal government. The analysis found that the legislation could boost ACO participation and create more Medicare savings.

Greater participation would lead to $280 million in savings from 2022 to 2031, offsetting a boost in shared savings for ACOs, the analysis found.

The legislation aims to reverse a slide in ACO participation that has occurred since Trump-era programs called for organizations to take on more financial risk. ACOs agree to take on financial risk and must repay Medicare if they don’t meet key quality and spending metrics but get a share of any savings they produce.

The bill would increase the amount of shared savings an ACO can achieve from the Medicare Shared Savings Program and modify the risk adjustment to better reflect community risk.

It also mandates the federal government explore health outcomes and racial disparities of Medicare beneficiaries who received care from an ACO.

The American Medical Association, the American Hospital Association, the Federation of American Hospitals, the American College of Physicians, NAACOS, AMGA, America’s Physician Groups and the Association of American Medical Colleges were among the groups to sign onto the letter.

The missive was sent to the leaders of the Senate Finance Committee and the House Ways and Means Committee. Both panels are playing an outsize role in what healthcare priorities will be included in the $3.5 trillion package.

Democrats have identified some major health priorities to include such as adding dental, hearing and vision benefits to Medicare. Democrats also hope to give drug price negotiation power to Medicare, a move that could also offset some of the cost.

But several industry groups are making a play to get their priorities included in the package, which is set to be considered this fall.

It remains unclear whether the legislation could be included in the package. Democrats are using a procedural tool called reconciliation to pass the $3.5 trillion package in the Senate via a simple majority and avoid a legislative filibuster. 

Reconciliation may only be used on budget bills, and it remains unclear whether the legislation meets the criteria.