With the right legal and policy backdrop, digital health tools will play a bigger and bigger role in healthcare. They offer a huge opportunity to improve patient care, reduce hospitalizations, avoid complications, and improve patient engagement—all while reducing costs. The Connected Health Initiative is continually looking for ways to ensure that patients and providers can use all the digital tools available to them. For that to happen, we need Congress to recognize the importance of digital medicine and telehealth tools, and address provisions that hinder their use. This is part of a series outlining key priorities for the 118th Congress in legislating on digital health.
When Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, it sought to transition traditional Medicare’s fee-for-service payment system to one that facilitates innovation and care coordination while also improving patients’ health outcomes. Digital health innovations include telehealth, remote physiologic monitoring (RPM), remote therapeutic monitoring (RTM), clinical decision support (CDS) software tools, and care coordination portals. These technologies can improve patient and physician shared decision-making about treatment plans, save costs, augment population health management, and better caregivers’ experience, and they already play a critical role in the transition to value-based care. We believe Centers for Medicare & Medicaid Services (CMS) should gather information and report on how these technologies lead to better, more cost-effective care. Empirical analyses like this would better enable policymakers to ensure patients and caregivers can leverage digital health tools where they are most effective. The 118th Congress should require or encourage CMS to collect data and produce analyses on the use of digital health tools and services across its alternative payment models.
Congress should also establish a third payment pathway between the Merit-based Incentive Payment System(MIPS) and Alternative Payment Models (APMs) that facilitates preparation to participate in APMs and ultimately take on financial risk, as well as reducing unnecessary reporting burdens. At least until there are many more APMs in which physicians can choose to participate and a higher proportion of physicians participating in them, the statute should continue to provide incentive payments for APM participation. The 118th Congress should consider reworking the incentive payments to address the problems that arise from the budget neutrality requirement in MIPS and facilitate transitions from MIPS to AAPMs—and should consider up-front payments to support investment in services like RPM and chronic care management by APM participants.
We know that Congress wants to ensure their constituents get the best value and have the best options in their healthcare. That means ensuring adequate support for value-based care services. CHI is here to show the ways Congress can improve the legal and regulatory environment for digital health companies, doctors, patients, and for the country.
 For further detail on these value-based care recommendations, see Letter from Morgan Reed, executive director, Connected Health Initiative, to Members of Congress re: Value-based care (Oct. 31, 2022), available at https://actonline.org/wp-content/uploads/2022-11-01-CHI-Response-to-VBC-RFI-FINAL.pdf.