Pay for Value: Medicare Announces Move to MACRA

In the marketplace, value is defined as “health outcomes achieved per dollar spent”. Among payors, Medicare is leading the way in shifting to a payment methodology that rewards providers when they provide high value services (high quality care delivered in the most cost-effective way possible).^[1] In April 2015, CMS (Centers for Medicare and Medicaid Services) announced the Medicare Access and CHIP Reauthorization Act (MACRA) which redesigns the way CMS will pay for physician and other provider services.^[2] At its core, MACRA establishes current physician fees as the baseline and commits virtually zero increases to those fees for the next 10 years. Physicians have the ability to increase those fees based on the “value” of the care they provide. Increased fees for those who provide high value care will be balanced by reduced fees for physicians who provide lower value care.

MACRA creates two payment tracks: MIPS (Merit-based Incentive Payment System) and APM (Advanced Alternative Payment Model). Most providers, including Starling, will be in MIPS when the program begins in 2018. Practices that are currently participating in Medicare-sponsored ACOs in which they share significant (50% or more) risk if costs exceed projections will be eligible to participate in the APM, in which all providers will receive an annual 5% increase in base fees.

Commercial health plans have already moved into value-based payments, and are sending us data to help us understand the populations we share with them. Starling’s decision to implement a shared EHR will allow us to document and report on the high value we are creating for patients right now, while identifying opportunities to improve further. Next time, we’ll talk about our plans and actions for 2016, which will set us up for our MIPS benchmark performance year in 2017.

Click here to see the Commonwealth Fund Quality Map>>

Click here to see the Advisory Board Presentation on MACRA >>

^{[1] See Commonwealth Fund of Quality map of value-producing physician practices in Connecticut
[2] Insert link to Advisory Board MACRA presentation}