Written Statement for the Record January 31, 2024 The National Association of ACOs (NAACOS) appreciates the opportunity to submit a statement to the House Energy and Commerce Subcommittee on Health in response to the hearing "Health Care Spending in the United States: Unsustainable for Patients, Employers, and Taxpayers." NAACOS represents more than 430 accountable care organizations (ACOs) in Medicare, Medicaid, and commercial insurance working on behalf of health systems and physician provider organizations across the nation to improve quality of care for patients and reduce health care cost. NAACOS members serve over 9 million beneficiaries in Medicare value-based payment models, including the Medicare Shared Savings Program (MSSP) and the ACO Realizing Equity, Access, and Community Health (REACH) Model, among other alternative payment models (APMs). NAACOS appreciates the committee’s leadership and commitment to improving access to health care and lowering costs. Our comments reflect the views of our members and our shared goals. APMS ARE A PLATFORM FOR INNOVATION AND COST SAVINGS A major pathway for improving access to health care and lowering costs is through advancing APMs. Over the last two decades, APMs have demonstrated that when providers are accountable for costs and quality and provided flexibility from fee-for-service (FFS) constraints, they are able to generate savings for taxpayers and improve beneficiary care. This emphasis on outcomes allows physicians and other clinicians to improve care coordination and prioritize primary and preventive care, keep patients healthy, and coordinate care across the continuum. Last year, NAACOS provided feedback to the House Budget Committee and House Ways and Means Committee on how APMs can help lower costs and increase health care access and quality in rural and underserved communities. [1] [2] ACOs are the Largest and Most Successful Model Leading Medicare’s APM Transformation In 2024, there are 603 ACOs coordinating care for 13.4 million Medicare beneficiaries. ACOs are a voluntary alternative to the fragmented FFS system that gives doctors, hospitals, and other health care providers the flexibility to innovate care and holds them accountable for the clinical outcomes and cost of treating an entire population of patients. With primary care as the backbone, ACOs employ a team-based approach that allows clinicians to ensure patients receive high quality care in the right setting at the right time. The ACO model also provides an opportunity for providers to work collaboratively along the continuum while remaining independent. Importantly, ACOs provide shared savings opportunities and enhanced regulatory flexibility that allows clinicians to maintain financial security while practicing medicine more freely. It’s clear these payment system reforms have been a good financial investment for the government. In the last decade, ACOs have generated more than $22.4 billion in savings with $8.8 billion being returned to the Medicare Trust Fund while maintaining high quality scores for their patients. The growth of APMs has also produced a “spill-over” effect on care delivery across the nation, slowing the overall rate of growth of health care spending. Last year, the Congressional Budget Office (CBO) also reported that actual Medicare and Medicaid spending between 2010–2020 was 9 percent lower than original projections.[3] While there are several influences for these changes in spending, improved care management and more efficient use of technology were factors highlighted by CBO. Moreover, providers in APMs help make the Medicare program stronger by reducing improper payments. Using enhanced data and analytics, ACOs regularly identify and report instances of fraud, waste, and abuse. Regulatory and Statutory Barriers Limiting Growth of APMs APMs have allowed physicians and other clinicians to change care delivery and improve care coordination while reducing costs. APMs are becoming more rooted in our health care system but growth has been slower than Congress’ original goal. It is essential to remove barriers to participation and give additional flexibility and tools to innovate care. Specifically, Congress should:
We thank the committee for this opportunity to provide feedback on this important hearing. NAACOS and its members are committed to providing the highest quality care for patients while advancing population health goals for the communities they serve. We look forward to our continued engagement on improving health care access and lowering costs. If you have any questions, please contact Aisha Pittman, senior vice president, government affairs at [email protected]. [1] https://www.naacos.com/assets/docs/pdf/2023/FINAL_NAACOSComments-HealthCareTaskForceRFI_10152023.pdf [2] https://www.naacos.com/assets/docs/pdf/2023/NAACOSWaysMeansRuralRFI10052023.pdf [3]https://www.cbo.gov/publication/58997#:~:text=CBO%20overestimated%20mandatory%20spending%20for%20health%20care%20in,9%20percent%20lower%20than%20CBO%20projected%20in%202010 |