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HHS advisory committee debates how to broaden participation in population-based total cost-of-care models
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Summary
Members of the Physician-Focused Technical Advisory Committee (PTAC) reflected on presentations about reducing barriers to participation in population-based total cost-of-care models, emphasizing MSSP simplification, specialist integration, conveners, primary care investment and geographic disparities.
Committee members on the Physician-Focused Technical Advisory Committee (PTAC) spent the meeting summarizing lessons from two days of public sessions on reducing barriers to participation in population-based total cost-of-care (PBTCOC) models and on supporting primary and specialty care transformation.
“MSSP is the chassis that we should be driving value‑based care on,” one PTAC member said while urging that the Medicare Shared Savings Program (MSSP) be simplified to make participation easier for providers. Members repeatedly contrasted MSSP and Merit-based Incentive Payment System (MIPS) pathways with Medicare Advantage (MA), saying current differences in risk‑bearing, payment tools and bonus structures create an uneven playing field.
Several members urged policy fixes to level that field: address MA’s STAR bonuses and risk adjustment; reduce MSSP features that erode predictable savings, including the 4% “clawback” and regression‑to‑the‑mean impacts; and allow MSSP participants to use savings to create MA‑like benefits such as lower deductibles. Members said those changes would help MSSP compete with MA and expand beneficiary choice.
Specialty integration, not just primary care, was a recurring theme. Multiple members said the committee still lacks effective, widely scaled examples that allow specialists to participate in total cost‑of‑care models while preserving necessary specialist functions. Ideas discussed included episode‑level public comparison tools (an “episode compare”), nested specialty models inside broader ACO arrangements and greater regional flexibility for specialty bundles.
Members also discussed the role of conveners and enablers: organizations that aggregate small providers or operate enablement services have helped scale participation from early adopters to wider markets. Suggestions included increasing primary care investment within fee structures — one member cited a 13:1 return on investment claim for primary care investment — and giving conveners flexibility to repurpose savings to drive adoption.
Committee members raised process issues and trade‑offs: simplicity versus necessary complexity to engage specialists; geographic disparities in participation and penetration of accountable care; and the importance of stable, consensus quality measures, with some members highlighting “patient goal attainment” as a prospective shared measure across payers.
PTAC members said they will collect the day’s input, incorporate public comments submitted to the committee’s request for information and produce a report to the secretary of the U.S. Department of Health and Human Services describing key findings and potential recommendations.
