May 09, 2019

Texas v. Azar Could Imperil Value-Based Transformation

The Trump Administration’s goal of value-based transformation could be imperiled if United States Court of Appeals for the Fifth Circuit agrees with the position taken by the U S Government and strikes down the ACA in its entirety.  The ACA created the Center for Medicare and Medicaid Innovation (“CMMI”) and provided an appropriation of $10 billion each decade for CMMI.  The ACA gives the Secretary of HHS the authority to develop new payment and service delivery models that reduce program expenditures while preserving or enhancing the quality of care for individuals in the Medicare, Medicaid, and CHIP programs.  Most recently, CMMI announced the Primary Cares Initiative, consisting of new payment models to transform delivery of primary care.  The administration has also updated Obama administration models, such as the Bundled Payment for Care Improvement – Advanced model that is now in its first year.  Section 3022 of the ACA created the Medicare Shared Savings Program, through which 538 ACOs were created, serving more than 12.3 million beneficiaries.  Should the Trump administration prevail, the underlying statutory authority used to advance its goal of increasing value-based care will cease to exist, creating uncertainty about the future of these models.