Q&A: Rep. DelBene Talks Fixes to ACOs, Affordable Care Act

Although accountable care organizations (ACOs) appear to be saving money for Medicare, they haven't caught on as fast as proponents would like. As part of our occasional series of interviews with members of Congress, MedPage Today Washington Editor Joyce Frieden spoke with Rep. Suzan DelBene (D-Wash.) about her legislation to improve ACOs and encourage more physicians to sign up for them; DelBene also spoke about changes she would like to see to the Affordable Care Act, among other issues.

The interview, which was conducted by phone with a press person present, has been edited for length and clarity.

Rep. DelBene, can you discuss your bill on ACOs, which is known as the Value in Health Care Act?

DelBene: Our legislation really tries to make sure that we have the right pieces in place to encourage more providers to move to an ACO model by doing things like increasing the shared savings that a beginner participant would receive, because that has been decreased and that makes it less attractive for folks to enter. We want to make sure that we modify the risk adjustments, to be more realistic, given the things that folks encounter, like health or other risk variables that might exist in their community. We want accurate benchmarks, so that folks aren't always competing against their own success in providing care. This has also been a challenge for some of our rural communities and smaller markets -- I think it's been referred to as the "rural glitch."

So, getting the incentives right, extending some of the time frames -- for example, the annual lump sum participation bonus, extending that for 6 years -- just really from talking to ACOs, hearing what they're doing, what's led to their success, and some of the challenges with the program in terms of particular deadlines or making sure the right metrics are in place, we want to make sure we're encouraging folks, and we want a path that has been successful for patients.

What kind of support is the bill getting?

DelBene: It's bipartisan legislation -- that's really important because these days you don't hear as much about bipartisan legislation. We do want to increase participation in these programs. So our legislation is really about increasing participation, and it would save us money. That's very important, especially as we're looking at legislation like we are right now with reconciliation. Lots of different folks have looked at how much money we saved -- one organization said that our legislation would help save $280 million over 10 years. So if we can have models that help to save money and improve outcomes, that's a great combination.

Speaking of the reconciliation bill, how do you feel about the healthcare provisions in the bill, such as adding dental, vision, and hearing benefits to the traditional Medicare program, adding a public option to the Affordable Care Act, and lowering prices for prescription drugs?

DelBene: The top priority that I have is making sure that we build on the Affordable Care Act towards universal access, and making sure that we make the premium subsidies that were in the American Rescue Plan permanent. That's a top priority of mine [and of the] New Democrat Coalition, where I serve as chair. The coalition also [hopes to address] Medicaid expansion. So those are two top priorities. And clearly, drug pricing is critical.

On Medicaid expansion, are you referring to a proposal to develop a federal "Medicaid-like" program for patients in states that haven't expanded Medicaid?

DelBene: There have been a few different proposals and I think we share the goal of making sure we address that, making sure we get coverage out to folks even in states that haven't expanded Medicaid.

And what are your views on the Medicare provisions in the bill?

DelBene: I'm on the Ways & Means Committee, and we're working through this right now. One of the important things that we want to do is make sure that we are addressing broad, critical needs. The premium subsidies in the Affordable Care Act prioritize underinsured and underserved communities, so that's why that's so important. We continue to have discussions and look at what we can do, and that's going to be an ongoing effort because we haven't closed on our committee's part of the legislation. (Editor's note: This interview was conducted last week. The Ways & Means Committee is holding a 2-day markup session this week for the reconciliation bill; it begins on Thursday.)

The recently released Medicare trustees report predicted that the Medicare Hospital Insurance Trust Fund would be depleted in 2026 -- and that was assuming no changes in the current Medicare Physician Fee Schedule, which the trustees admitted was "not expected to keep pace with the average rate of physician cost increases." What are your thoughts on increasing physician pay under the Medicare program?

DelBene: Well, going back to where we started, one of the great opportunities we have is to look at ways we can save money and get better outcomes, and if we get more providers in value-based models, that will help us improve care for seniors and help protect the trust fund.

Has there been any progress on another bill you've sponsored of interest to physicians -- the bill to streamline the prior authorization process?

DelBene: Yes, this is a pretty straightforward piece of legislation that has very strong bipartisan support. I think it's pretty straightforward to say that we should be able to do something better than fax machines for getting prior authorization; we could use some technology there to speed things up, to create standards so people can get responses more quickly and get care out more quickly. I think there are over 200 co-sponsors now, and we need 218 for a majority. And we have had that in the past Congress so I think we will definitely have strong bipartisan support to move the legislation. So we're going to continue to push there.

Does that bill include a provision for standardizing electronic attachments?

DelBene: That is part of our bill; we create that to be a standard process so there's one form, not everybody doing things differently. It also helps providers so that they don't have to try to figure out what form they're giving to different insurance companies, to make that a consistent process.

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