AMGA Offers Recommendations to Help Congress Realize Promise of Value-Based Care

Alexandria, VA – As part of its commitment to transition the healthcare system to one based in value, AMGA today submitted a letter to Congress outlining its legislative priorities with extensive recommendations intended to help lawmakers build on earlier legislative achievements and enact needed reforms to enable providers participating in federal programs to deliver the highest quality care to patients in the most efficient and effective manner.

“This new Congress has the opportunity to build on past gains and continue the shift to value-based care,” said AMGA President and CEO Jerry Penso, M.D., M.B.A. “AMGA’s recommendations serve as roadmap for policymakers who want to move past the vision of value-based care and help enact policies that will deliver the benefits of a value-based system to providers and patients across the country.”

In 2015 Congress took an important step in moving Medicare from a fee-for-service model toward value-based care when it passed the Medicare Access and CHIP Reauthorization Act. To help Congress realize the goals of the law’s Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (Advanced APM) program, AMGA offers a series of policy recommendations to ensure there is meaningful provider participation. Specifically, AMGA is recommending that Congress ensure that a sufficient number of clinicians participate in MIPS for earnings to be meaningful for high performers. For the Advanced APMs, AMGA suggested that Congress adjust the program’s rules and thresholds for eligibility so that providers have a realistic opportunity to participate and succeed. AMGA is concerned that absent such reforms, both MIPS and the Advanced APM pathway will not reflect Congress’ original intentions to move the payment system to one based on value. Through participation in these federal programs and others in the commercial sector, AMGA members are leading the shift to value-based care, but critical reforms to a variety of these programs are needed to ensure a successful transition. Providers that deliver care in a value-based model need a complete understanding of their patient population to best develop and deploy an appropriate care delivery model. The reforms detailed in the letter indicate how Congress can modify existing policies and programs to help ensure these providers have the support they need. Recommendations include reforms to the Medicare Shared Savings Program, incentives to integrate behavioral health care, as well as timely access to federal and commercial claims data and substance use disorder data.

“We’re well past the time for looking at value-based care as a concept,” Penso said. “Now, it’s time to work to implement policies and incentives to aid providers who have invested in the staff and technology needed to deliver care in these new, value-based models. The legislative priorities and recommendations we’ve outlined for Congress today indicate AMGA’s and our members’ commitment to this needed transition.”

The full letter may be accessed on AMGA’s website.


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.


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