PTAC members urge sustained investment, simplification to advance multi‑payer alignment

Krishna Ramachandran, a PTAC member, opened the meeting by telling participants that PTAC will issue a report to the secretary of the Department of Health and Human Services describing the committee’s key findings on improving multi‑payer alignment and value‑based care.

Committee members spent the session reflecting on lessons from expert presentations and state demonstrations. Lauren, a PTAC member, said the work requires moving integrated systems “from a transactional relationship to a partnership model,” and stressed the importance of conveners, capacity building and stable funding to sustain practice change. “The funding of that kind of role is really critical,” she said.

Lee, another PTAC member, described alignment as “culture change in a community” that needs multiyear commitment and reliable revenue. He said including Medicare Advantage in alignment efforts matters because reaching a large share of patients—he cited a 60–70% threshold discussed earlier—makes provider engagement more feasible.

Larry, a PTAC member, and others repeatedly called for simplification of programs and metrics. “Whenever you need an actuary to calculate something, you have a barrier,” Larry said, arguing that simplifying measurement and payment rules would lower implementation burdens. Several members said top‑down participation by federal entities such as the Centers for Medicare & Medicaid Services (CMS) helps ensure payer participation.

Speakers emphasized three recurring pillars for operationalizing alignment: a convening entity or integrator to coordinate payers and providers; shared, interoperable data infrastructure (including health information exchanges) to provide timely analytics and attribution; and predictable prospective payments or advanced funding to sustain transformation. Walter, a PTAC member, summarized that pragmatic alignment requires “timely data, clear attribution, ideally a concise core quality measure set, and equitable payer cost sharing so providers aren't forced to cross subsidize transformation.”

Panelists debated the balance between standardization and local flexibility. Josh, a PTAC member, said standardization promotes comparability and oversight but noted it can limit local choice; he argued calibration across a spectrum of rules is needed because some aspects of risk adjustment and payment remain inherently complex and require technical expertise.

Members pointed to state examples—participants referenced OneCare Vermont and a Pennsylvania payment model—that illustrate how upfront investment and governance can help scale reforms, but they also noted unresolved questions about how to operationalize Medicare Advantage engagement at scale and what legal or market flexibilities might be necessary to sustain long‑term financing and convening.

The committee confirmed logistical details for the next session: it will reconvene at 9 a.m. Eastern tomorrow, with a public comment period scheduled at approximately 10:50 a.m. PTAC will compile these reflections and the day’s expert testimony into its report for the HHS secretary.

The meeting was adjourned.