MACRA, Value-Based Care and the Quality Payment Program

By nThrive | Posted: 04/12/2017

As the Trump administration begins its second quarter, health care organizations continue to pay close attention, hoping to spot clues into potential implications to the MACRA’s Quality Payment Program. But no matter what happens, nThrive recommends that health care organizations continue to arm themselves with a comprehensive knowledge of MACRA as the industry advances toward value-based care.

Indeed, value-based care is inevitable – and that’s a good thing. As health care continues to advance toward value-driven care, whether it be through MACRA as we know it or a tweaked version, we do know there is consensus to continue moving away from fee-for-service by volume in favor of fee for value models.

What is value-based care?

The goal of value-based care is to lower health care costs and improve quality and outcomes. The Centers for Medicare & Medicaid Services (CMS) is driving the charge to value by developing of various programs to optimize health system performance by reforming how health care is both delivered and paid.

What is MACRA?

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is a law designed to improve Medicare by helping clinicians focus on care quality in order to make patients healthier. MACRA was passed with strong bipartisan support; passing the House of Representatives with a 392-37 vote and the Senate with a 92-8 vote.

MACRA brings about a fundamental change to the way we assess and pay for health care by delivering a path toward delivering cost-effective and outcomes-based health care. Under MACRA, a new unified provider payment framework, the Quality Payment Program (QPP), was created that rewards health care providers who render better care not just more care.

What is the Quality Payment Program?

The Quality Payment Program (QPP) is a new payment system that is designed to reward clinicians for the quality of care they provide to Medicare patients, instead of the quantity of care. The QPP, created under the MACRA, replaces the sustainable growth rate formula (SGR), which was established in 1997 to control the cost of Medicare payments.

As CMS’s latest payment program, the QPP went into effect on January 1, 2017. The QPP framework allows eligible clinicians to choose to participate in one of two payment pathways:

  1. The Merit-based Incentive Payment System (MIPS)
  2. Advanced Alternative Payment Models (AAPMs)

How to prepare for MACRA’s QPP?

The QPP data collection period began on January 1, 2017 so it is crucial to expedite planning and execution of your organization’s approach to this mandatory program. nThrive has developed various helps to ensure success as you navigate this new value-based reimbursement health care environment.

MACRA Webcast – Becker’s Health Review Sponsored

Topics addressed in this on-demand webcast help health care providers understand and adapt to the MACRA regulations as health care moves toward a value-based. Click here to view the webcast.

Free MACRA Readiness Assessment

Schedule a call with our MACRA expect for a complimentary strategy discussion geared towards your individual group or practice’s situation today. Contact us to schedule a free MACRA readiness assessment.

MACRA Readiness Checklist

nThrive’s MACRA readiness checklist will guide you as you begin constructing your own successful value-based reimbursement strategy. Click here to download the MACRA readiness checklist.