WASHINGTON, DC, December 11, 2024 — America’s Physician Groups welcomes the newly released 2024 Report to Congress from the Centers for Medicare & Medicaid Services’ Innovation Center as documenting the key contributions that the center has made recently to critical health system transformation. “Many of our APG member groups have participated in these innovation models since the center’s inception, and used them to transform their own operations to improve the outcomes for patients and to achieve savings and quality goals,” said Susan Dentzer, APG’s President and Chief Executive Officer. “As with each successive presidential administration, the outgoing Biden administration leaves behind an impressive track record for the incoming Trump administration to continue to build on.”
The seventh biennial report issued by the center covers model activities conducted between October 1, 2022 and September 30, 2024 (the period of report). CMS has estimated that more than 57 million Medicare and Medicaid beneficiaries — as well as individuals with private insurance in multi-payer model tests — have been involved in, or received care, or will receive care, from more than 192,000 health care providers and/or plans participating in the center’s models and initiatives.
APG’s members are particularly grateful for the following Innovation Center actions cited in the report:
- The redesign and relaunch of the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, which has grown from 53 ACOs and about 350,000 covered lives in 2021 to 132 ACOs and 2.1 million covered lives in 2023, the center’s report said. Especially important has been the aspect of the model that tested payments adjusted for social risk to steer more resources to ACOs caring for underserved populations. APG members have seen special success in the High Needs version of this model that has reduced avoidable hospitalization for older adults with complex health care and social needs. APG looks forward to working with the incoming Trump administration on an extension of the model beyond its planned end in 2026.
- Models that have steered upfront infrastructure payments to primary care groups, and encouraged transition from fee-for-service Medicare and greater accountability for quality and costs through more flexible prospective primary care payment, as in the announced ACO Primary Care Flex (ACO PC Flex) Model. Although APG groups are larger and more experienced in taking on risk than many organizations that have entered or will enter such models, “APG believes that these measures are essential to building a far stronger and more resilient system of primary care,” Dentzer said.
- The new “Quality Pathway” adopted by the center, which is elevating the focus on quality improvement in model design and evaluation. As the new report notes, the Innovation Center’s statutory authority specifies that a payment model may be expanded if the testing results demonstrate it will either reduce spending without worsening quality or improve care without adding to costs. “To date, the CMS Innovation Center has only expanded models based on cost savings,” the report notes. But based on the Quality Pathway, the center will now emphasize quality “from model design through evaluation,” the report notes. APG salutes this new direction as most appropriate for areas of health care in which it is important to invest and improve quality, rather than attempting to exact savings out of areas such as primary care in rural areas, and safety net care, that have historically experienced underinvestment from the market and at the national policy level.
“We congratulate Innovation Center director Liz Fowler, PhD, and her many colleagues for this report and the achievements during their tenure leading the center,” Dentzer said. “They will leave behind more important building blocks for system transformation that a strong CMS and innovation center can carry forward in the next administration.”
About America’s Physician Groups
America’s Physician Groups is a national association representing approximately 360 physician groups with approximately 170,000 physicians providing care to nearly 90 million patients. APG’s motto, “Taking Responsibility for America’s Health,” represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care. Visit us at www.apg.org.
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