THE CHALLENGE:
Traditional Medicare ACOs can qualify for a 5% bonus on their Medicare Part B if they meet certain revenue or patient count thresholds specified by the Medicare Access and CHIP Reauthorization Act (MACRA). On January 1, 2021, those MACRA thresholds were scheduled to increase dramatically, and with that increase, the M+ team calculated that approximately one-third of ACOs would lose their bonus eligibility.
THE OBJECTIVE:
To build a robust and diverse coalition of stakeholders to advance legislation that would freeze MACRA thresholds at the 2020 levels, ensuring all ACOs would retain eligibility for the bonus payments in 2021.
THE OUTCOME:
We leveraged an advocacy coalition we had formed in 2018—the Next Gen ACO Coalition—along with our partnerships and relationships in Washington, DC, to successfully lobby Congress to postpone the increase. As a result, ACO patient and revenue financial bonus thresholds remained at 2020 levels.
GO FURTHER:
M+ had formed the Next Gen ACO Coalition recognizing that the participants in the Next Gen ACO model had unique lobbying and advocacy needs. Because the model is small, with only about 40 participants, the participating providers were looking for more ways to collaborate and communicate around their aligned goals. To better serve the needs of Next Gen ACOs, the M+ team brought together our deep relationships with the Centers for Medicare & Medicaid Services (CMS), our technical knowledge and our provider contacts to form the Coalition, which grew to about 20 participants this year.
By design, the Coalition is uniquely suited to tackle problems like the proposed 2021 MACRA threshold increase. Addressing these nuanced issues requires our team to develop supporting data, leverage relationships on Capitol Hill and with CMS, and deploy advanced advocacy strategies to build partnerships that advance our objectives. In this case, the team’s victory required a multi-prong strategic effort to move the legislation over the goal line. To expand our influence with Congress and achieve success, M+ implemented several initiatives, including:
Creating a sign-on letter: To demonstrate for members of Congress that the threshold issue mattered to their constituents, the M+ team worked with ACO partners, McDermott clients and other contacts in identifying more than 500 physician practices to sign a letter to Congress. They also assembled a toolkit to help providers further share the letter, including details about how to identify and contact the relevant Congressperson, making it easier to organize and mobilize the community.
Tapping powerful connections: The team leveraged strong relationships with contacts in a number of well-known national organizations, along with other lobbyists and firms, to foster a group effort that helped cover enough ground and connect with enough people to get the legislation over the Hill.
Looking Ahead
This year, the Coalition will rebrand as the Value Based Care Coalition and will bring on new members, including other two-sided risk Medicare ACOs and Direct Contracting Entities.
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