Inside MedPAC: MSSP vs. Medicare Advantage with Michael Chernew | Episode 204

Vivek Garg, MD, President and CEO of the National Committee for Quality Assurance (NCQA), joins Josh Israel, MD and Sean Cavanaugh to talk about the future of quality measurement in healthcare. While acknowledging clinician frustration with sometimes fragmented or conflicting quality metrics, Dr. Garg shares NCQA’s strategy to harmonize CMS quality measurement frameworks including the new Advanced Primary Care (APC) program. APC leverages interoperable data and outcome-oriented signals to align healthcare stakeholders in value-based care. Ultimately, the goal is to shift to a measurement system that supports primary care clinicians in delivering high-quality, patient-centered care that rewards clinicians for improving patient outcomes.

Jonas Goldstein, Senior Vice President of Transformation at Aledade, and Annette DuBard, MD, Senior Vice President of Clinical Strategy, join Josh Israel, MD, and Sean Cavanaugh to discuss Aledade’s participation in the CMS ACCESS model through a new program called Aledade Access which aims to improve patient outcomes by proactively engaging patients in controlling their hypertension. Jonas explains how Aledade Access will use AI-driven technologies to deliver evidence-based insights to primary care physicians within their current workflows, keeping them at the center of patient care. Dr. DuBard shares that she’s most excited about the opportunity to expand support for patients between visits, all while strengthening the relationship between primary care physicians and their patients.

Michael Chernew, PhD, professor of healthcare policy at Harvard Medical School, joins Josh Israel, MD, and Sean Cavanaugh to discuss the Medicare Payment Advisory Commission (MedPAC) and its role in the Medicare program, including Medicare Advantage (MA) and the Medicare Shared Savings Program (MSSP). Dr. Chernew, who served as MedPAC chair from 2020-2026, shares how MedPAC provides evidence-based recommendations to Congress on payment policies, access and quality of care in Medicare. They examine Medicare solvency, cost-effectiveness concerns in both MA and MSSP, as well as larger challenges to improving the healthcare system for patients and physicians.

Halle Tecco, author of the book “Massively Better Healthcare: The Innovator's Guide to Tackling Healthcare's Biggest Challenges,” joins Josh Israel, MD, and Sean Cavanaugh on the podcast to discuss ways to improve the healthcare system through innovation. Tecco shares that a very important focus is on alignment, not only between margin and mission, but in figuring out how to engage patients with new technologies. Tecco also explores how patients, physicians and other key stakeholders can all be involved in innovation and change in the healthcare system.

Jacob Shiff, chief AI and technology officer at the Centers for Medicare and Medicaid Services Innovation Center (CMMI), joins Josh Israel, MD, and Sean Cavanaugh to dive deeper into the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. The model focuses on improving patient outcomes while encouraging clinicians to utilize technology-enabled solutions to deliver personalized, preventive care to those with chronic conditions, like hypertension and diabetes. Shiff shares that the goal is to give primary care physicians more support, while offering patients affordable and convenient care options. With continuous advancements with artificial intelligence (AI) and technology, Shiff hopes the ACCESS model will allow clinicians to use these advances to better engage with patients to improve outcomes. The Centers for Medicare and Medicaid Services (CMS) has extended the ACCESS application deadline to May 15: https://www.cms.gov/priorities/innovation/innovation-models/access Learn more about Aledade’s participation in ACCESS: https://aledade.com/newsroom/aledade-news/aledade-joins-cms-access-model

Brad Briner, North Carolina state treasurer, and Alex Mullineaux, Aledade regional market president, join Josh Israel, MD, and Sean Cavanaugh to discuss the state health plan’s new preferred provider strategy. The goal of this approach is to improve patient health outcomes and reduce costs by connecting patients with clinicians that have a proven record of  high-quality, cost-effective care. Treasurer Briner and Alex share how this strategy came about, the benefits for patients and how North Carolina hopes to scale the plan in the future. In phase one, the state health plan approved partnerships with three networks to support this initiative, including Aledade.

Paul Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, joins Josh Israel, MD, and Sean Cavanaugh to discuss the recent decision by the Centers for Disease Control and Prevention (CDC) to move several vaccines (including rotavirus, influenza and COVID-19) from a universal recommendation to shared clinical decision-making. While shared clinical decision making has always been an option for physicians and patients, Offit provides practical tips for clinicians navigating these conversations, advising physicians to be empathetic to patient fears, but also to be passionate in explaining the severe risks of vaccine-preventable diseases.

Amelia Knopp and her father, Ryan Knopp, MD, from Stone Creek Family Physicians in Manhattan, Kansas, join Josh Israel, MD, and Sean Cavanaugh to discuss Amelia’s experience with the health care system following a shocking leukemia diagnosis. They share how this diagnosis set Amelia and their family on a journey that they describe as “health care at its best.” Amelia emphasizes the importance of trust in the physician-patient relationship, and how advocating for patients and providing clear communication helps build a better patient experience. Ryan notes how his daughter’s experience underscores the importance of value-based care in ensuring that physicians are invested in the relationship with their patients and providing high-quality, accountable care.

Catherine Olexa-Meadors, head of growth and partnerships at Town Hall Ventures, joins Josh Israel, MD, and Sean Cavanaugh to discuss the recently announced ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model from the Center for Medicare and Medicaid Innovation (CMMI), also known as the CMS Innovation Center. They explain the new payment system, which includes outcome-aligned payments tied to demonstrating improved patient outcomes, and how advances in technology, specifically in digital patient engagement, could help this model succeed. They also explore challenges, including the delay in the announcement of payment rates and the concern that patients not in an accountable care organization (ACO) may not have someone monitoring the total cost of care.   Watch the full episode on YouTube   Listen to Episode 193: Breaking down CMMI's new strategy with Abe Sutton, director of CMMI, and Farzad Mostashari, MD

Shawn Martin, executive vice president and CEO of the American Academy of Family Physicians (AAFP), joins Josh Israel, MD, and Sean Cavanaugh to discuss challenges with the future of primary care, particularly independent primary care practices. Martin believes that value-based care has helped sustain rural health care practices and that the Medicare Shared Savings Program (MSSP) will serve as the foundation for value-based care moving forward. Martin stresses the benefits of partnering with support organizations, like accountable care organizations (ACOs), in succeeding in value-based care and outlines opportunities for the AAFP to partner with ACOs to support physician independence, provide value-based care training and advocate for rural health care funding.