HealthCare Roundtable e-News – March 25, 2024

 

 

Roundtable Federal Policy Priorities

Roundtable Board Adopts Updated Federal Policy Priorities

The Roundtable Board of Directors reviews and updates the Federal Health Care Policy Priorities for Public Sector Purchasers at the beginning of each Congress. The policies are designed to guide the Roundtable’s engagement and advocacy agenda throughout the two years of each Congress. Earlier this year, in response to a changing Congressional environment, the Board considered edits to the current policy. The Board recently adopted an updated policy for the balance of the 118th Congress.

Over the course of the next few months, we will be sharing this document with Members of Congress and congressional staff as we advocate on behalf of our policy priorities. We encourage our members and friends to also share this document as you engage with your Congressional Delegation.

To read the updated Federal Policy Priorities click here.

Top News

HHS’ Office of the Inspector General Publishes Brief on the Impact of its Oversight Work on Medicare Advantage Prior Authorization

The Department of Health and Human Services (HHS), through its Office of Inspector General (OIG) recently published a brief that highlighted the impact of its oversight work pertaining to prior authorization practices used by Medicare Advantage (MA) organizations. The brief highlights particular cases, like the denial of a medically necessary walker for a 76-year-old post-polio syndrome patient and the delay of an MRI for a 69-year-old experiencing persistent pain, both of which were denied based on technicalities. The attention brought by these cases spurred the Centers for Medicare & Medicaid Services (CMS), industry leaders, and Congress into action, resulting in regulatory changes, congressional hearings, and industry initiatives aimed at reducing delays and inappropriate denials of care. CMS implemented regulatory reforms to streamline the prior authorization process, while congressional hearings underscored the risks to enrollees’ health posed by such denials and delays. Furthermore, providers including United, Cigna, and Aetna responded by reducing the number of services requiring prior authorization, easing administrative burdens, and enhancing access to essential care for enrollees.

 

Group of Bipartisan Representatives Author a Letter Urging Proper Implementation of the No Surprises Act

A group of bipartisan representatives sent a letter to the Department of Health and Human Services (HHS), the Department of Treasury, and the Department of Labor (the Departments) urging them to ensure the No Surprises Act (NSA) is implemented properly. The letter is in response to recent updates on the implementation of the NSA and acknowledges efforts by the Departments to address challenges through proposed rules. However, stakeholders express ongoing concerns regarding minimizing burdens, ensuring patient access, and monitoring the process. The letter urges finalization of proposals including enabling parties to include all items associated with a patient encounter and requiring additional information sharing between payors and providers. Despite positive changes, unresolved issues such as qualified payment amount (QPA), network shrinking, and compliance enforcement persist. The letter highlights the potential consequences such as access issues for patients and the burden on providers.

 

Medicare’s Shift: Covering Weight-Loss Drug Wegovy for Heart Risk Signals Policy Evolution

Medicare’s decision to cover the new weight-loss drug Wegovy for reducing the risk of heart attack and stroke in enrollees marks a significant departure from its usual policy of not covering weight-loss medications. This shift is part of a broader trend where popular anti-obesity medications, such as GLP-1s like Wegovy, are gaining approval for additional conditions beyond obesity. The FDA’s recent approval of Wegovy prompted Medicare to review its coverage policies, allowing Part D prescription drug plans to cover weight-loss drugs for any additional FDA-approved indications. However, despite this policy change, the high cost of Wegovy, priced at approximately $1,300 per month, may deter immediate widespread coverage by Medicare plans. Moreover, drugmakers are actively lobbying Congress to lift the Medicare ban on covering weight-loss drugs, but concerns about increased government spending, as highlighted by the Congressional Budget Office, may pose challenges to this effort, impacting the shares of companies like Novo Nordisk and Eli Lilly.

Administrative Action

The Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) recently released an evidence-based guide for hospital leaders to improve healthcare worker wellbeing. The Impact Wellbeing Guide: Taking Action to Improve Healthcare Worker Wellbeing is the latest addition to the Impact Wellbeing campaign, which was launched in October 2023. The Impact Wellbeing Guide aims to support hospital executives in making significant workplace improvements to combat the mental health crisis that healthcare workers face. The Guide itself provides a step-by-step process for hospitals to make organizational-level changes to improve the mental health of its employees.

Congressional Action

  • The U.S. Senate Finance Committee held a hearing to discuss the President Biden’s Fiscal Year 2025 Health and Human Services (HHS) Budget, which was released on March 11th as part of the President’s larger budget for the U.S. Government. HHS Secretary Xavier Beccera was the sole witness and answered questions from the committee on budget items including drug pricing, pharmacy benefit manager (PBM) reform, mental and behavioral health, nursing homes, and the Inflation Reduction Act (IRA). Healthsperien’s detailed notes can be found here.

 

  • The House Energy and Commerce Committee advanced 27 pieces of legislation, 17 related to health care, to the U.S. House of Representatives. Of the numerous bipartisan health care measures, the Committee unanimously approved three bills related to Alzheimer’s care. Other measures that passed include provisions on maternal and child health, the healthcare workforce, and medical services in rural areas. The Committee also supported the reauthorization of a program to reduce health care provider burnout as well as initiatives targeting traumatic brain injuries, Down syndrome research, and cancer detection. The only piece of legislation that did not have unanimous support when passing the Committee was the Kidney PATIENT Act, a bill that impedes CMS from transitioning oral-only drugs for chronic kidney disease into a different payment system.

Medicare

  • The Centers for Medicare & Medicaid (CMS) announced the ACO Primary Care Flex Model (ACO PC Flex Model), a new five-year voluntary model for primary care providers in eligible Accountable Care Organizations (ACOs) that treat Medicare beneficiaries with innovative, team-based, person-centered proactive care. The ACO PC Flex Model will provide a one-timed advanced shared savings payment to cover costs associated with forming an ACO if necessary and administrative costs for required model activities, and monthly prospective primary care payments (PPCPs) to ACOs to ensure flexibility in providing care that best suits individuals’ needs. CMMI will test this model within the Medicare Shared Savings Program and will focus on and invest in low revenue ACOs. The ACO PC Flex Model will begin on January 1, 2025. Interested organizations must apply as either new ACOs or renewing ACOs to the Shared Savings Program, which are open until June 17, 2024. The ACO PC Flex Model Request for Applications (RFA) is planned to be released in the second quarter of 2024. More information can be found on the CMS published fact sheet and the FAQs.

 

  • The Medicare Payment Advisory Commission (MedPAC) held its March Public Meeting to discuss several issues related to Medicare payment policy. Specifically, the Commission held sessions on assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources, preliminary analysis of Medicare Advantage quality, Medicare’s Acute Care Hospital at Home program, and update on trends and issues in Medicare inpatient psychiatric services. Healthsperien was there to cover the March MedPAC meetings. Click here to access Healthsperien’s comprehensive summary.

Research

New data from the Commonwealth Fund’s 2023 International Health Policy Survey found that across 10 high-income countries, women were more likely to act as a caregiver to a family member compared to men. In all 10 of the surveyed countries, at least one in five women acted as a caregiver. Across the questioned nations, findings were relatively uniform with women being more likely to be caregivers. In the US, out of all adults who said that they acted as a family caregiver, 26 percent of women said that they acted as a family caregiver, compared to 22 percent of men. Moreover, the study found that women providing informal care to a family member in the US were more likely find it stressful, likely due to a higher caregiving burden. 40 percent of women providing care found the endeavor stressful, with just 29 percent of men reporting the same. The survey also noted that the inequitable distribution of caregiving responsibility likely stems in part from women being twice as likely to leave the workforce as men during the COVID-19 pandemic.


Mark your calendar:


Roundtable’s Congressional Forum

June 6, 2024

Washington, DC


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November 6-8, 2024

The Mayflower Hotel, Washington, DC


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