Alexandria, VA – AMGA today emphasized the need for Congress to address a number of policy changes to support the transition to value-based care. AMGA urged Congress to enact key reforms so that providers have access to administrative claims data, patients with chronic disease benefit from care management, and the Medicare physician payment system supports providers’ investments in the value-based care delivery systems.

In a letter to key lawmakers, AMGA detailed the legislative changes that Congress should enact to create a pathway to value. AMGA is prepared to work closely with Congress on these critical reforms, which are necessary for providers to assume responsibility for the quality and cost of care they deliver.

“AMGA members need the proper tools for the shift to value to succeed,” said AMGA President and CEO Jerry Penso, M.D., M.B.A. “Congress has an opportunity to implement these critical reforms and build on its past work to support the shift to value-based care.”

Access to Claims Data

AMGA regularly surveys its membership on what obstacles and barriers prevent them from transitioning into value-based models. The members consistently cite access to administrative claims data as one of the most significant impediments to taking on financial risk for their patient populations. To overcome this problem, AMGA worked closely with the Senate Health, Education, Labor and Pensions (HELP) Committee on legislative language that would require commercial plans to share claims data. In the letter, AMGA encouraged Congress to ensure this provision is included in an upcoming healthcare legislative package.

“Knowing who provided care, what was done, when, and where a treatment was provided is critical for any value-based model to succeed,” Penso said. “Without timely access to claims data, our providers simply won’t have a complete patient history and will be making care decisions with incomplete information. Requiring payers to share claims data with providers is a common sense solution to a problem that has stymied a broader adoption of value-based models of care.”

Ensuring access to claims data is only part of AMGA’s recommendations, as members with access to claims data report they must contend with various data standards. To correct this problem, AMGA recommended that Congress require all payers and providers to standardize their data submission and reporting processes. Policymakers also should work to harmonize quality measures for all providers in value-based arrangements. AMGA developed a set of evidence-based measures to aid in this process.

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