ObamaCare bump doesn’t help those who need it

 The March 2021 stimulus bill greatly expanded subsidies for ObamaCare health insurance plans.  But this increase in subsidies is due to expire at the end of 2022, and congressional Democrats have been looking to extend it as part of the proposed Build Back Better Act.

BBB advocates argue that renewing the hike in subsidies is necessary to maintain the basic affordability of health insurance to low-income, working adults. Yet, subsidized ObamaCare plans already cost enrollees much less than individuals typically contribute to employer-sponsored insurance, and the Affordable Care Act (ACA) specifically prohibits most workers with an offer of employer coverage from receiving them — excluding those who need help the most.

Subsidies that automatically increase in proportion to premiums have been shown to push up prices. Whatever the merits of the stimulus legislation, in terms of boosting aggregate demand, the case for extending its costly bump in subsidies into an era of inflation is therefore very weak. 

From 2014, the Affordable Care Act required health insurers to cover individuals with major pre-existing conditions on the same terms as those who signed up before they got sick. The upshot of this was that millions of healthy people stopped buying health insurance, and premiums on the individual market more than doubled from 2013 to 2017. Yet, the market was saved from complete collapse by the legislation’s establishment of federal subsidies for the purchase of insurance, which automatically expand to limit premiums and out-of-pocket costs as a share of income.  

To curb the fiscal cost of this provision, Congress had limited eligibility for ACA subsidies to households with incomes less than 4 times the Federal Poverty Level ($54,360 for an individual in 2022, and $111,000 for a household of four) who lacked an offer of “affordable” health insurance from their employer (defined as a premium less than 9.61 percent of household income). But higher earners remained fully exposed to soaring premiums — creating political anxiety for Democrats, who had been enthusiastic about the legislation.

Having recaptured Congress for the first time since the ACA’s implementation, Democrats used the March 2021 American Rescue Plan Act (ARPA) to eliminate the income cap on eligibility for subsidies. That stimulus bill also greatly expanded the magnitude of assistance. Whereas federal subsidies under the ACA would have paid 22 percent of the cost of insurance for a 28-year-old earning $40,000, under ARPA it would pay 61 percent. Individuals earning $20,000 had been required to contribute up to 4 percent of their income in premiums under the original ACA, but under ARPA the federal government would pick up the whole tab. 

To limit the scorable fiscal cost, ARPA’s subsidy hike was set to expire at the end of 2022.  Assessing the proposed Build Back Better Act, the Congressional Budget Office estimated that making it permanent would cost $220 billion over the first 10 years. The exclusion of those with an offer of “affordable” employer-sponsored insurance coverage is even more significant.

In 2020, only 18 million Americans received health insurance from the individual market, but 164 million were covered by their employers — only 5 million of whose plans exceeded the “affordability” threshold. While the tax subsidy for employer-sponsored insurance would be worth around $4,000 to a family of four with a household income of $80,000, those who lacked an offer of “affordable” coverage from their employers were entitled to around $9,000 in federal subsidies for the purchase of an ACA plan from the exchange. ARPA expanded this to around $12,000.

Without the exclusion of those who have an offer of employer-sponsored insurance, the fiscal cost would be astronomic. But further inflating subsidies for those on the individual market makes little sense.

According to the Medical Expenditure Panel Survey, in 2019 the median post-subsidy premium for a single adult earning between $12,500 and $25,000 was already much lower on the individual market ($858) than the average employee contribution to employer-sponsored insurance ($1,560). For those earning $37,500 to $50,000, the gap was less, but subsidized coverage on the individual market was still cheaper ($1,536 vs. $1,678).

ARPA’s bump in subsidies for ObamaCare plans is, therefore, not necessary to maintain the basic appeal of the individual market. Nor is a subsidy that excludes the workers who currently face the highest premiums a good way to make health insurance affordable for people who most need help.

In fact, it is likely to have the opposite effect. Subsidies that automatically increase with premiums tend to increase prices. Indeed, one study estimated that less than half of ACA subsidies are passed through to intended beneficiaries. By further expanding subsidies, such that the federal taxpayers will pay 100 percent of the premiums for anyone with an income less than $20,000, ARPA potentially makes this problem far worse — providing a bonanza for insurers to enroll individuals who never have had interest in purchasing or using health insurance, while further loosening the few remaining checks on the growth of health care costs

Chris Pope is a senior fellow at the Manhattan Institute.

https://thehill.com/opinion/healthcare/3470375-obamacare-bump-doesnt-help-those-who-need-it/

Is Remote Work Working Out?

The Issue:

Remote work became a necessity for a very large share of workers at the beginning of the COVID pandemic. The experience has provided a valuable opportunity to study how remote work impacts both firms and workers, and about the prospects for a new balance in working modalities. Will the pandemic experience change the way we work in the future? What are the distributional implications when there are limited opportunities for many people to work from home? How will working from home affect workers' sense of isolation and companies' productivity?  Evidence from the Survey of Working Arrangements and Attitudes (SWAA), offers important insights.

There was an estimated twelve-fold increase in full paid days worked from home between January and May 2020.

The Facts:

• The share of workers laboring from home rose dramatically at the outset of the pandemic and, while it has diminished, continues at a much higher rate than before March of 2020. As shown in the chart, there was an estimated twelve-fold increase in full paid days at home between January 2020, when it was 5 percent, and May 2020, when this number rose to 60 percent – in other words, an increase in roughly one day per month to 12 days per month. This was not spread evenly, of course, with frontline workers and others not having the opportunity to work remotely. Since the beginning of 2021 the number of full-time paid days at home has stayed within the range of 40 percent to 50 percent.
• There are three modes of work, and the division of workers across these modes is largely correlated with education and income. Estimates from the SWAA, a monthly online survey run jointly by the University of Chicago, MIT, Stanford, and ITAM in Mexico that began in May 2022, suggest that after COVID 55 percent of employees will need to work fully on-site because jobs such as those in manufacturing and retail do not allow for working from home. These workers tend to have less formal education and to be lower paid than those who able to work from home. About 15 percent of workers will be fully remote.  They work in jobs such as IT support and back-office functions and are often contractors. The remaining 30 percent of employees will be in hybrid situations, splitting time between working on site and working remotely. These are professional and manager-level jobs, employing people with more formal education and who are better paid than those in the other two categories. In fact, the variation in the opportunity to work remotely is almost entirely driven by differences in education and income levels rather than gender, race, or age. Working from home is viewed by many as a perquisite of a job, with an estimated value of about an 8 percent pay increase (more so in tech and finance jobs), equivalent to the compensation from a pension or a healthcare plan. But because the option of working from home tends to be less available to lower-paid workers, the shift to working from home benefits better paid workers more than lower paid workers on average.
• About one-third of employees would like to be fully remote post-COVID, a little more than one-fifth would like to be fully on-site and the remaining 45 percent prefer a hybrid arrangement. Along with this breakdown, the SWAA further asked, for those who preferred hybrid arrangements, the number of days people would like to work from home.  Of the 45 percent who preferred some work from home, about one fifth (22 percent) preferred working from home one day per week, about one third preferred two or three days per week (31 percent for each) and the remaining 16 percent preferred working from home for four days per week. The most cited reason people liked working from home was time saved commuting – when asked to list the top three benefits of working from home, this was cited by 60 percent of respondents. (The average American commutes about one hour each day.) Two other often-cited reasons are a flexible work schedule and less time needed to get ready for work, cited 49 percent and 47 percent of the time, respectively. Three other reasons listed in the survey were a preference for a quieter environment, spending more time with friends and family, and having fewer meetings (cited in 38 percent, 37 percent and 16 percent of responses, respectively).
• There are differences in preferences for working from home by age and gender. There is a greater preference for in-person work among the youngest employees and those over 55. Those in the middle age group who have young or school-aged children have a mildly higher preference to work from home – for them, the desire to be around because of childcare somewhat outweighs the challenges of being in a more chaotic, nosier environment, despite the fact that those people tended to find it difficult to work from home. In terms of gender, the levels of work from home during the pandemic for men and women have been very similar and have tended to rise and fall together.  Post-pandemic, people want to work from home more than what employers are likely to allow, and the gap between the desired and allowed work from home is almost 50 percent larger for women than for men.  The reasons for this are not fully known, but could be related to occupational structure, industrial structure, full time versus part-time work and discrimination, among other reasons.
• Despite concerns at the outset of the pandemic, working from home had a positive impact on productivity. Evidence from SWAA finds that hybrid working from home increases average productivity by about five percent.  In fact, the productivity gains seem to be rising as companies and employees learn how to take advantage of remote work opportunities. In-person work helps with creativity and innovation through formal and informal meetings.  It can also be good for fostering an esprit de corps.  But this seems to be outweighed by the benefits of less time commuting and preparing for in-person work – about 40 percent of survey respondents said that they spent more time working because of the time saved by not commuting, and time that would have been spent in meetings may be more productively spent otherwise. Hybrid working offers the benefits of both meeting in person on days spent in the office and saving commuting time on days worked from home. Perhaps as a consequence of these increasing productivity gains, employers' plans for the average number of days per week working from home have increased from less than 1.6 days in early 2021 to more than 2.1 days in February 2022.
• The shift to remote working has had some spillover effects, but not necessarily those that were the focus of concern at the outset of the pandemic. There was a view in the early days of the pandemic that commercial real estate would take a big hit.  But companies are not planning to cut office space by much, likely because they still need to accommodate workers who come in less than five days per week and scheduling to save space is challenging. Two large surveys of companies that I helped run, one with the Federal Reserve Bank of Atlanta looking at Chicago and the other with the Bank of England looking at Nottingham, have both found reports of office space demand dropping by only 2 to 3 percent. In terms of residential properties, there is evidence that people are relocating out of the dense centers of large cities towards lower density suburbs, or even more remote exurbs or very rural locations.  A co-author and I call this the "donut effect" as big cities like San Francisco, New York, Los Angeles, and Chicago have lost about 10% of their population from the city centers.  One potentially big effect that demands careful policy consideration is the impact of remote working on public transport as urban transport networks like the New York Subway, commuter rail, and BART in San Francisco are seeing permanent reductions in usage. BART predicts that its ridership will be down 30 percent in the long run.  Revenue shortfalls from declining ridership are very damaging to systems that have high fixed costs. Public transportation helps keep cars off the road and reduce traffic congestion and disproportionately serves the lower-income and middle-income communities.

What this Means:

The growth of working from home has generated a boom in the development of new technologies that increasingly supporting remote work, and these technologies are likely to continue to improve – in fact, the flow of new patents supporting working from home doubled within the first 18 months of the pandemic. The shift to remote work will have massive impacts on society. Outsourcing and offshoring will grow as footloose fully remote workers gain locational flexibility. One consequence is workers' continued move from city centers to suburbs and more rural locations. There are also potential effects that will increase labor supply. Older workers, those caring for young children or older relatives, the disabled and those living in rural areas gain easier access to employment, particularly part-time employment. The greater ease of working shorter and more flexible hours from home is also very appealing to many people who would otherwise not be in the labor force. These increases in the supply of labor could drive growth. Finally, working from home is a huge welfare benefit to the roughly 50 percent of employees who can do this, saving them over an hour per day in time that would otherwise be spent commuting and getting ready for work. This should continue the trend of greater time devoted to leisure activities, something we can all look forward to.

https://econofact.org/is-remote-work-working-out

Biden admin drops challenge to Texas Medicaid waiver

 

• The Biden administration has dropped its challenge to a Trump-era Medicaid extension in Texas after deciding it’s no longer a good use of federal resources, according a letter the CMS Administrator Chiquita Brooks-LaSure sent to Texas’ Medicaid director Friday.
• The decision ends a lawsuit that had stretched on for almost a year over a waiver extension approved in the last days of the Trump administration. Texas’ main hospital lobby called the waiver’s survival a relief, and the state’s Republicans agreed late last week.
• The waiver, which expands Medicaid managed care, provides funds for uncompensated care and allows for the creation of nontraditional care delivery programs, is worth billions of dollars annually. It’s currently slated to run through 2030.

The Trump administration in last January approved a decadelong extension of Texas’ Medicaid waiver, just days before President Joe Biden was sworn into office. The state applied for ane tension early, as the waiver was scheduled to expire in fall of 2022.

Prior to approval, Trump’s HHS didn’t hold a public notice and comment period, citing the pandemic.

The Biden administration revoked the federal green light in April, arguing the CMS had “materially erred” in granting Texas’ request by not undergoing the proper public comment period, the agency explained in a letter rescinding approval.

Texas sued in May, arguing the CMS didn’t give the state notice of its intent to reconsider the waiver’s approval. Its attorney general said the Biden administration was using the reversal as a smokescreen to pressure the state into a full Medicaid expansion under the Affordable Care Act. Texas is one of 12 states that have yet to do so.

In August, a federal judge allowed the waiver to temporarily stand, while the state and federal government negotiated its details.

In Friday’s letter, Brooks-LaSure said the CMS is committed to public notice and comment periods on Medicaid demonstrations, but is allowing Texas’ demonstration to stand, “as CMS has concluded that it is not the best use of the federal government’s limited resources to continue to litigate this matter.”

“This should resolve the issue without the need for further litigation and will create no disruption to the people who rely on Texas’ Medicaid program, since the demonstration has been in effect” since January, Brooks-LaSure said.

Texas’ uninsured rate is the highest in the nation and twice the national average, at 17.3%. Critics of its Medicaid waiver argue the state could expand coverage to more residents if it fully expanded Medicaid under the ACA.

Texas hospitals cheered the CMS’ decision, while noting the importance of further coverage expansion.

“This is a step forward for the health of Texas and brings some relief for hospitals and the patients they serve. Today’s decision creates certainty following months of ambiguity during an ongoing pandemic,” John Hawkins, president and CEO of the Texas Hospital Association, said on Friday. “We will continue to underscore the need for coverage expansion, rates that more closely match the cost of care, and a stable uncompensated care pool.”

Texas Gov. Greg Abbott, a Republican, said he applauded the CMS in a statement on the reversal, saying it would allow the state to maintain an “efficient and effective Medicaid” program.

https://www.healthcaredive.com/news/challenge-texas-medicaid-waiver/622613/

Tenet says ‘cybersecurity incident’ disrupted hospital operations

 

• Tenet, one of the largest for-profit health systems in the U.S., said it experienced a “cybersecurity incident” last week that disrupted some acute care operations.
• Most critical functions have been restored, while affected facilities are beginning to resume normal operations, according to a statement on Tuesday from the Texas-based operator.
• Tenet didn’t disclose the nature of the incident, the affected facilities or whether patient data was accessed. 

After experiencing the cybersecurity incident, Tenet suspended access to the affected health IT programs, took steps to increase security and is currently undergoing an investigation into the matter, the system said.

According to WPTV, a local news outlet in Florida, telephone service and some IT systems at at least two Tenet hospitals in the West Palm Beach area went offline starting last Wednesday. The station reported doctors and nurses using paper charts and having to leave the hospitals to use their phones because they weren’t functional inside.

At the time, a Tenet spokesperson declined to say whether the company was experiencing a cyberattack, WPTV reported.

Tenet, which operates 60 hospitals and roughly 550 other care sites across 34 states, is the latest health system to be affected by a cybersecurity breach, which have been increasing in severity in the U.S. and in the healthcare industry.

Cybersecurity breaches in the sector hit a record high last year, compromising a record volume of patient data, according to cybersecurity firm Critical Insights. In 2021, 45 million people were affected by healthcare cyberattacks, triple the 14 million affected in 2018, according to the firm’s recent analysis of HHS breach data.

Cybersecurity has long been underfunded in hospitals, even before COVID-19 swallowed up more resources. In addition, the Biden administration warned about the potential for Russian cyberattacks in February, leading a major hospital lobby to urge facilities to shore up their cyber defenses.

Cyberattacks are hazardous for any business but particularly disastrous for hospitals, as — on top of steep financial losses — they can also contribute to loss of life, according to a report from the Ponemon Institute.

More recently, last Thursday a federal cybersecurity office alerted healthcare providers of an “exceptionally aggressive” ransomware group called Hive. Hive has been active since June last year, though it has increasingly zeroed in on the healthcare sector to encrypt and steal data from its victims using common tactics like phishing attacks.

https://www.healthcaredive.com/news/tenet-says-cybersecurity-incident-disrupted-hospital-operations/622692/

Employers reevaluating health benefits amid tight labor market

 

• Facing worker recruitment and retention challenges in a tight labor market, almost two-thirds of U.S. organizations (64%) plan to boost efforts to address employee healthcare affordability over the next two years, a survey from Willis Towers Watson found. The response comes as healthcare costs show signs of accelerating, the advisory firm said Tuesday.
• Almost all employers (95%) in the survey said they expect to offer virtual care to meet demand for medical and behavioral health services, and 87% of respondents said improving mental health benefits is a top priority.
• Even as employers take steps to address rising costs, confidence in sponsoring healthcare benefits over the next decade is at its highest level in more than 10 years, according to WTW, a global advisory and broking company. The poll of 636 employers showed 84% were very confident that their organizations would still be offering healthcare benefits 10 years out, compared with 38% who were very confident in 2011.

Employers are having to navigate a host of challenges in 2022 including accelerating inflation and healthcare costs. They’re also facing difficulties attracting and keeping workers and a worsening mental health picture for employees and their families as the pandemic has taken a toll, WTW said. “Many employers find themselves in the middle of a perfect storm,” Lindsay Hunter, the firm’s senior director of health and benefits, said in the report.

The cost per employee of employer-sponsored health insurance jumped 6.3% last year in the highest annual increase since 2010, according to a survey released late last year from Mercer. The consulting firm said it was unclear if the surge was temporary, resulting from patients resuming care delayed due to COVID-19 or represented the start of a new period of higher cost growth.

A number of organizations including employer groups and outside health ventures, seeing a need for fresh solutions to the persistent problem of rising healthcare costs, are looking to disrupt the industry with new approaches to save employers money without reducing care access or quality.

About nine out of 10 (94%) of employers surveyed in the WTW poll identified managing healthcare benefit costs as their No. 1 priority over the next two years. When asked about the biggest hurdles they see for their healthcare strategies, 73% cited increasing prices due to inflation and provider consolidation. More than half (54%) said lack of employee awareness about where to find programs to support their needs is a key challenge.

Employers “are looking for ways to make healthcare more affordable for themselves and their employees,” Hunter said.

Strategies to improve affordability include boosting quality and outcomes (55%) and adding or expanding low- or no-cost coverage for some benefits (41%). About a third (32%) of employers also expect to make changes to their employees’ out-of-pocket costs over the next two years, while 21% expect to revise health plan payroll contributions.

The shift to remote work during the pandemic has contributed to more mental health struggles among employees and their families, WTW said. In response, two-thirds of employers said ensuring that their health and well-being programs support remote workers will be a key priority over the next two years, and 62% plan to enhance programs for family members.

Virtual care likely will become a long-lasting feature of employers’ healthcare strategies as the pandemic subsides, WTW said. The survey found 55% of employers think expanding virtual care will help decrease healthcare costs, and 50% believe it will improve outcomes.

WTW expects more employers will embrace virtual care for services such as physical therapy and lactation counseling, to better manage costs.

https://www.healthcaredive.com/news/employers-are-reevaluating-health-benefits-amid-tight-labor-market-survey/622759/

ACLA, AdvaMed boost lobbying to replenish COVID-19 testing fund

 

• The American Clinical Laboratory Association and AdvaMedDx, the medical device lobby’s division representing diagnostics makers, have joined with more than 60 organizations calling on congressional leaders to immediately replenish a fund that enabled uninsured people to access COVID-19 testing.
• Citing insufficient funds, the COVID-19 Uninsured Relief Fund stopped accepting new claims for testing on March 22. ACLA,  AdvaMedDx and the other signatories of the letter warn the funding expiration may put “the most vulnerable members” of communities at risk of losing resources to diagnose new COVID-19 infections.
• The authors of the letter want Congress to act immediately to replenish the fund and prioritize the protection of “Americans’ ability to access the critical diagnostics tools they need to fight the pandemic” regardless of their insurance status. The letter, sent to congressional leaders on Wednesday, comes as COVID-19 cases are on the rise in all but six states and Washington, D.C., with the omicron BA.2 subvariant continuing to spread across the U.S. 

Lawmakers came together early in the pandemic to allow healthcare providers to seek reimbursement for any testing or treatment of uninsured people with a COVID-19 primary diagnosis. However, with the White House unable to extract more funding from Congress, it emerged last month that the support was coming to an end, first for testing and treatment and shortly thereafter for vaccines.

The ending of the support programs has sparked a broad response from the healthcare industry. In a letter to Democrat and Republican leaders in the House and Senate, ACLA, AdvaMedDx and other groups affected by the change made the case for the restoration of the fund. 

“Without it, many of our nation’s most vulnerable communities may lose access to testing, treatments and vaccinations, placing themselves and others at risk of infection. What’s more, without assurances to replenish funding, providers across the country are left without recourse to handle the influx of demand from uninsured Americans, forcing them to make decisions about the long-term sustainability of providing COVID-19 tests and services,” the letter states.

According to ACLA, the fund enabled its members to perform more than 8 million tests for uninsured individuals last year. The uninsured testing was made possible by Congress’ willingness to replenish the fund as needed. 

ACLA and its cosignatories have advocates in Congress. Sen. Patty Murray, D-Wash., used a hearing on the reauthorization of FDA user fee programs to push for the urgent provision of fresh COVID-19 funding.

“We’ve got to get this done — because families are counting on us to provide communities the tests, treatments, and vaccines they need to keep people healthy, protect our hard won progress against this pandemic, and keep our country ready for whatever comes next,” Murray said.

Opposition to providing more funding in Congress comes as other countries are scaling back and dismantling their COVID-19 testing programs. In England, free PCR and rapid antigen testing is now limited to specific groups such as residents of care homes and people working in the state healthcare service. People who develop symptoms are advised, but not legally required, to stay home and cannot access free tests.

https://www.healthcaredive.com/news/acla-advamed-congress-covid-testing-fund/622900/

'False and misleading’ criticism of direct contracting stoked model controversy: stakeholders

 

• Controversy around a direct contracting model the Biden administration rebranded and redesigned earlier this year following pressure from progressive Democratic lawmakers and single-payer advocates was excessive and not based in fact, according to some members of the accountable care community.
• Grassroots opposition to the Trump-era model, in which physicians can accept either full or partial capitation as payment in traditional Medicare, ramped up late last year and reverberated up to Capitol Hill in 2022. Critics slammed direct contracting as a thinly veiled effort to privatize the Medicare fee-for-service program, even as hundreds of providers voiced their support.
• The National Association of Accountable Care Organizations felt these concerns were “very false and misleading,” said David Pittman, NAACOS senior policy adviser, at NAACOS spring conference on Friday. “If politics could kill an ACO model, that would be devastating.”

The Trump administration unveiled the original direct contracting model in 2019, with the goal of coordinating primary and specialty care, while allowing access to enhanced benefits. It offered a higher level of risk and reward than other ACO models at the time, which garnered it strong support from many health systems, physicians and medical group organizations.

Supporters said holding physicians accountable for outcomes meant patients would be more likely to receive team-based, preventative care that improved outcomes while lowering costs.

However, critics argued the model was a step toward privatizing Medicare by allowing a variety of entities, including those owned by private equity firms, to manage patient care, and would increase costs in the cash-strapped program while harming patient access.

Antagonistic rhetoric around the model grew in intensity late last year, with members of Physicians for a National Health Program, which supports a single-payer system, staging a protest in front of the HHS building in Washington, D.C., in December.

The issue eventually caught the attention of lawmakers. Direct contracting came under increased fire during a February hearing of the Senate Finance Committee.

Chairwoman Elizabeth Warren, D-Mass., called on the administration to end the model immediately, saying in opening remarks that direct contracting would open the door for “insurers that are already scamming Medicare and dozens of investor-owned organizations” to cover beneficiaries while pocketing “as much as 40% in profits.”

“President Biden should not permit Medicare to be handed over to corporate profiteers,” Warren said.

However, regulators maintained it would be disruptive to cull the model completely. More than 200 provider groups called on the government to amend direct contracting instead.

In late February, the CMS announced it would retain the model — albeit with numerous changes and a new name: Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.

Now, ACOs are saying the issue was blown out of proportion.

The discussion on Capitol Hill was rooted in a “real lack of understanding” around the beneficiary protections and cost investments inherent in ACOs, said Melanie Matthews, CEO of physician group Physicians of Southwest Washington.

“The unfortunate thing is that a number of us share the opinion that a lot of that discussion was just not grounded in fact. And that was not a positive thing that came out of this,” Corey Rosenberg, ACO REACH model lead at the CMS Innovation Center, said.

Gary Jacobs, executive director for VillageMD’s Center for Public Policy, said that the value-based primary care network anticipated direct contracting would be a political issue after it was introduced late in the Trump administration.

But “the argument that we can game the system to make money is bullsh--,” Jacobs said.

Panelists noted the negative rhetoric — which some argued was initially based on well-founded concerns around private equity in healthcare before snowballing — also challenged the ongoing push toward value-based care.

“This is just as threatening to the underlying ACO movement as it is to the underlying direct contracting model,” Matthews said.

According to Andrew Allison, CEO of direct contracting entity On Belay Health Solutions, it’s important for healthcare organizations to “never assume” that elected representatives understand the minutiae of their industry or the programs they’re involved in. Many ACOs assumed the heat would blow over, but quickly found themselves on the wrong side of the messaging debate as public opinion swung against the model.

“We need to stay on the offensive and keep the rhetoric positive,” Allison said.

https://www.healthcaredive.com/news/direct-contracting-medicare-reach-cms-controversy/622969/