A fundamental change is well underway in healthcare payment models, with a shift toward value over volume. While this transition is occurring industrywide, CMS is accelerating the pace of reform, largely through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This bipartisan legislation changes the way providers are reimbursed for traditional Medicare services through the Quality Payment Program (QPP), which over time ties an ever increasing portion of payment to quality.
Beginning in 2019, MACRA-modernized reimbursement methods will be extended to private industry payers, including Medicare Advantage, under the CMS All-Payer Combination Option. Adopting payment models that align with this provision can help simplify administration, strengthen the fabric of trust between Medicare Advantage plans and providers, improve member/patient health outcomes, and enhance revenue for both plans and providers.
With Medicare-eligible beneficiaries increasingly choosing the Medicare Advantage option, such plans are on the path to becoming the predominant Medicare product offering. Enrollment in Medicare Advantage plans reached 35% of the Medicare-eligible population in 2017 (about 20 million) and is expected to rise to 50% by 2025 (about 38 million). In this time of growth, plans should look strategically at untapped opportunity in value-based care
and adopt payment models that can help support better member/patient outcomes and/or lower costs for older adult populations.
This is the first in a three-part white paper series that explores opportunities to leverage MACRA in Medicare Advantage. The second paper explains how to design advanced alternative payment models (A-APMs) that align with MACRA. The third paper discusses how to operationalize a collaborative approach with A-APMs to enhance success.
To read the full white paper, click here.