Week in Washington 04/18/2024

Medicare Accountable Care Organization Analysis

The Congressional Budget Office (CBO) released a new report on Medicare Accountable Care Organizations (ACOs). They find that ACOs led by independent physician groups are associated with greater savings. They also found certain factors like weak incentives for providers to reduce spending, lack of resources necessary for providers, and favorable selective entry into ACO models are associated with limited savings.  

Sleep Apnea Drug

 Eli Lilly announced that its weight-loss drug Zebound improved symptoms around sleep apnea. Around 20 million Americans suffer from some form sleep apnea so expansion of the uses of the drug could increase uptake.

ACA Enrollment Issues

KFF reported that a lawsuit was filed against several call centers that used consumer’s information to fraudulently enroll individuals into plans. The lawsuit would open the door for a class action lawsuit for those affected by the call centers.  The issues appear to be primarily focused on exchanges operated by CMS. CMS released a statement recently that it was taking the issue seriously and looking into both operational and regulatory changes to reduce unauthorized activity.

ACA Timeline

CMS recently released its timeline of key activities for calendar year 2024. Of note, the delay in the final submission deadline for risk adjustment will delay actual risk adjustment collections and payments by about a month.

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