Congressional Action Needed to Realize Promise of Value-Based Care

Alexandria, VA – AMGA today emphasized the need for Congress to address a number of policy changes to support the transition to value-based care. AMGA urged Congress to enact key reforms so that providers have access to administrative claims data, patients with chronic disease benefit from care management, and the Medicare physician payment system supports providers’ investments in the value-based care delivery systems.

In a letter to key lawmakers, AMGA detailed the legislative changes that Congress should enact to create a pathway to value. AMGA is prepared to work closely with Congress on these critical reforms, which are necessary for providers to assume responsibility for the quality and cost of care they deliver.

“AMGA members need the proper tools for the shift to value to succeed,” said AMGA President and CEO Jerry Penso, M.D., M.B.A. “Congress has an opportunity to implement these critical reforms and build on its past work to support the shift to value-based care.”

Access to Claims Data

AMGA regularly surveys its membership on what obstacles and barriers prevent them from transitioning into value-based models. The members consistently cite access to administrative claims data as one of the most significant impediments to taking on financial risk for their patient populations. To overcome this problem, AMGA worked closely with the Senate Health, Education, Labor and Pensions (HELP) Committee on legislative language that would require commercial plans to share claims data. In the letter, AMGA encouraged Congress to ensure this provision is included in an upcoming healthcare legislative package.

“Knowing who provided care, what was done, when, and where a treatment was provided is critical for any value-based model to succeed,” Penso said. “Without timely access to claims data, our providers simply won’t have a complete patient history and will be making care decisions with incomplete information. Requiring payers to share claims data with providers is a common sense solution to a problem that has stymied a broader adoption of value-based models of care.” 

Ensuring access to claims data is only part of AMGA’s recommendations, as members with access to claims data report they must contend with various data standards. To correct this problem, AMGA recommended that Congress require all payers and providers to standardize their data submission and reporting processes. Policymakers also should work to harmonize quality measures for all providers in value-based arrangements. AMGA developed a set of evidence-based measures to aid in this process. 

Chronic Care Management

AMGA recognizes the toll of chronic disease on our nation. To address this critical issue, Medicare in 2015 began reimbursing providers for Chronic Care Management (CCM) under a separate, billable code in the Medicare Physician Fee Schedule to support non-face-to-face care management. Under current policy, Medicare beneficiaries who receive these services are subject to a 20% coinsurance requirement. Consequently, only 684,000 out of 35 million eligible Medicare beneficiaries with two or more chronic conditions benefitted from CCM services over the first two years of the payment policy. AMGA recommended Congress remove the coinsurance payment requirement, which will encourage the code’s use and support chronic care management and improve patient health. AMGA asserted that Congress should enact the Chronic Care Management Improvement Act (H.R. 3436), which would waive Medicare’s CCM code coinsurance requirement.

Physician Payment System

Congress also should require Medicare to implement fully the Medicare Access and CHIP Reauthorization Act, which reformed the physician payment system so that it supports to move to value.  As it stands, however, the program’s implementation has excluded too many providers from the program, which undermines the ability of those providers who do participate to earn a meaningful payment adjustment.

The full letter is available is available here.


About AMGA

 AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.


Media Contact:

Sharon Grace
Chief Communications Officer
703.838.0033 ext. 393