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.