H.R. 5347: Health Care Efficiency Through Flexibility Act

This bill, titled the Health Care Efficiency Through Flexibility Act, aims to modify provisions under the Social Security Act related to the Medicare Shared Savings Program (MSSP) to enhance the efficiency of quality reporting by Accountable Care Organizations (ACOs). Here are the key components of the bill:

1. Amendments for Quality Reporting

The bill proposes changes to the requirements for how ACOs report their quality measures. Specifically:

• It removes a redundant phrase to clarify that ACOs are responsible for submitting data.
• It mandates that the Secretary of Health and Human Services ensure the availability of specific collection types for quality measures reported by ACOs for performance years 2025 through 2029. These collection types include:
  • Electronic clinical quality measures.
  • MIPS clinical quality measures.
  • Medicare Clinical Quality Measures for ACOs in the MSSP.
• The bill specifies how data completeness will be assessed. ACOs may not be penalized if data exclusions are justified, provided the ACO meets other requirements.

2. Digital Quality Measure Reporting Pilot Program

The second major aspect of the bill introduces a pilot program for digital quality measure reporting, applicable from performance years 2028 through 2032. Under this program:

• The Secretary will establish a pilot program where selected ACOs must report on specific quality measures using digital methods.
• ACOs will be chosen to participate based on their applications.
• For each year of the pilot, only two specific quality measures will need to be reported by participating ACOs, and they will not be required to report on any other measures during that year.
• The Secretary cannot consider data from measures not reported during the pilot when assessing ACO performance or calculating quality scores.
• Technical assistance will be provided to help ACOs with the new reporting requirements.
• An analysis of the pilot program, along with recommendations and proposed timelines for possible future reporting requirements, will be publicly shared by 2032.

Overall Impact

The Health Care Efficiency Through Flexibility Act seeks to streamline the quality reporting process for ACOs participating in the Medicare Shared Savings Program. By introducing specific digitized collection methods and clarifying data completeness requirements, the bill aims to improve the efficiency and accuracy of healthcare quality assessments during the specified performance years.

Relevant Companies

• UNH - UnitedHealth Group: As a major healthcare insurance provider, changes in Medicare reporting requirements may affect how UnitedHealth manages its partnerships with ACOs and the data they report.
• ANTM - Anthem, Inc.: Anthem could be impacted by adjustments in quality metrics and the reporting processes associated with ACOs in Medicare.
• CNC - Centene Corporation: As a managed care company, Centene's interactions with Medicare ACOs may influence their operational processes and strategic goals.