Making the most of MACRA

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, makes sweeping changes to how Medicare pays physicians and other clinicians for the services they provide. But more than simply addressing physician payments, the law aims to dramatically improve patient outcomes and reduce health costs by rewarding medical professionals for the overall quality of care they provide, rather than the number of services and procedures they perform.

MACRA repeals the Medicare physician sustainable growth formula (SGR), largely unpopular among doctors because of the unpredictability of payment reimbursements on a year-to-year basis. Instead, MACRA is an explicit articulation of CMS's (and Congress's) value-based agenda – that is, moving the majority of fee-for-service (FFS) payments to a system based on value and quality of care, and in the process, accelerating the transformation of health care in the United States.

The new payment approach – which CMS calls its Quality Payment Program (QPP) – will base compensation to providers on patient health outcomes, activities that improve clinical practices, efficient use of medical resources, and the meaningful use of electronic health records.

How can doctors make the most of MACRA?

See MACRA as an opportunity

MACRA offers strategic and financial opportunities for most health care organizations. To make the most of their chances, health care providers and payers must acquire the capabilities to accommodate the law as it takes hold and exposes them to greater risk. Finding the best way to comply with MACRA will afford organizations the stability and freedom to gain market share in the new health care economy.

Physicians, facilities, health systems and payers will need to work together to determine the best MACRA course of action. How should they adjust their short- and long-term strategies in response to MACRA's new requirements? How are competitors reacting to MACRA and what effect will the law have on their organization? What are the near-term tactical decisions required to be successful?

Get strategic about MACRA

A new Optum white paper—“Making the most of MACRA”—will discuss the law's implications, the gaps that organizations may need to close and the possibility for all stakeholders to work together to carve out a favorable position in relation to the law's requirements. The white paper will help readers:

• Understand the basics and the nuances of the new Quality Payment Program (QPP) and its dual paths: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) methodologies
• Focus on transitioning to the QPP in the 2017 performance year and preparing for further evolution in 2018 and beyond
• Anticipate changes in the health care industry that may follow as a result of the law; these could include further consolidation, tighter physician/health system alignment, and growing collaboration between payers and providers
• Decide whether MIPS or Advanced APM is the best choice for their long-term stability and growth

Download the white paper and learn more about how provider organizations can leverage MACRA to foster greater collaboration to enhance care delivery and improve population health management strategies.