THE SITUATION:
In early 2022, the Accountable Care Organization (ACO) community faced a crisis: Some Members of Congress and stakeholders were calling for an immediate end to the direct contracting model, and the Administration appeared to be seriously considering this option.
The resulting impact would disrupt patients and participating healthcare providers. Many accountable care entities had invested substantially in setting up this accountable care delivery model for their patients, including hiring care managers and other care coordination staff, investing in infrastructure and informing their patients about the new benefits that would flow from participation in the model. In addition, because of the waivers and flexibilities in the model, providers can expand access and care in ways not permitted in fee-for-service Medicare without a demonstration project. Termination of the model would have required rolling back these newly expanded services and left patients without access to critical benefits they had become accustomed to receiving.
THE CHALLENGE:
McDermott+Consulting (McDermottPlus) and the Value Based Care Coalition—a national collaborative of more than 25 members dedicated to advancing Medicare two-sided risk, total cost of care models—saw the need to mount a rapid response. A McDermottPlus team, in partnership with the value-based care community, moved to combat misinformation and skepticism about the direct contracting model among dozens of key decision-makers, while positively impacting future models.
OUR OBJECTIVE:
The McDermottPlus team served as a key resource to the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), providing innovative ideas to revise the direct contracting model and address stakeholder criticisms. This critical thought leadership, in partnership with the broader value-based care community, marshaled in a transitional approach to winding down certain highly political elements of the model (like the Geographic Direct Contracting track) while enabling a continuation of successful models for providers and patients, who were already significantly invested in those programs.
THE OUTCOME:
In late February 2022, rather than terminating the direct contracting model, CMS announced a redesigned ACO model known as REACH: Realizing Equity, Access, and Community Health.
The McDermottPlus team worked with a broad-based group of stakeholders to advocate for many of the changes that were ultimately implemented in the new REACH model: Months earlier, through proactive issue-spotting around the direct contracting model, the team had already put together a roadmap of suggestions that CMS could use to help advance value-based care. Because of that forward-thinking approach, when the crisis emerged, the Coalition was prepared to suggest a thoughtful, reasonable solution to law- and policymakers.
MOVE FASTER:
The McDermottPlus team drew on several core strengths to respond to the crisis quickly, bringing together policy knowledge, communications strategy and relationships rooted in decades of collaboration.
Policy Knowledge: Having worked with ACOs since they first appeared, the team has a nuanced, detailed grasp of the history and understand the related issues better than most. Their deep subject matter familiarity was critical to the speedy response.
Communications Strategy: Leveraging the existing Value Based Care Coalition and other industry relationships—including many of the trade and professional associations in the space—to help create one cohesive voice, McDermottPlus joined a powerful stakeholder group to create the necessary lobbying power within days. The team also took their message to traditional news outlets and social media to bolster public opinion.
Relationships: The Value Based Care Coalition is a leader in the stakeholder community and closely collaborates with other associations, coalitions and advocacy groups. The team can draw on strong relationships with hundreds of policymakers, healthcare providers, industry and political contacts and other key players at a moment’s notice to achieve their objectives. In this case, the team drafted a letter signed by 200 providers, a Hill letter signed by members of Congress and a letter signed by 14 former Obama Administration members in support of ACOs.
WHAT’S NEXT:
The McDermottPlus team continues to help Value Based Care Coalition members and others adapt to the new REACH model and take part in it successfully.
Learn more about the McDermottPlus Health Advocacy, Policy & Lobbying Strategies.
GO DEEPER:
On this Health Policy Breakroom Podcast episode, Aisha Pittman (Vice President of Policy at Premier Inc.) and Mara McDermott (Vice President, McDermott+Consulting) discuss how the renamed ACO REACH Model better aligns with the purpose of encouraging providers to coordinate care to people with Medicare and better reach participants in underserved communities.