MACRA: The series


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The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) represents a tectonic shift in how providers are reimbursed for the services they provide to Medicare fee for service beneficiaries. MACRA shifts away from the financial certainty of fee for service reimbursement, adjusting provider reimbursement based on performance on quality measures, IT utilization, performance of clinical improvement activities, use of resources relative to peers, and participation in “Alternative Payment Models.” While on the surface this may seem like it has little to do with health plans in the commercial, Medicare Advantage, or Medicaid space, in reality MACRA has broad and wide-ranging implications for other payers. This is a major piece of legislation  that will reshape the way in which healthcare is paid for. Milliman is developing a series of papers that examine the impacts of MACRA on providers, alternative payment models, and health plans.

Inside Medicare’s episode payment models

By L. Daniel Muldoon, Pamela M. Pelizzari | 20 July 2017

The Centers for Medicare and Medicaid Services released final rules on January 3, 2017, and May 19, 2017. This paper outlines the major provisions of the final rules and suggests possible implications for affected providers.


MACRA and Medicare Advantage plans: Synergies and potential opportunities

By Christopher Kunkel, Drew Osborne, Lynn F. Dong, Michael J. Polakowski, Noah Champagne, Charlie Mills | 21 February 2016

While MACRA primarily affects Part B clinicians, there are numerous implications, synergies, and opportunities for Medicare Advantage plans.


Will the Medicare Supplement market have “2020” vision in the world of MACRA?

By Kenneth L. Clark | 28 September 2016

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will affect the Medicare Supplement industry in calendar year 2020.


Challenges and opportunities with obtaining Qualifying APM Participant status

By Charlie Mills, Christopher Kunkel, Pamela M. Pelizzari | 18 August 2016

This paper explores both the challenges and the opportunities associated with participating in an Advanced Alternative Payment Model (APM) and obtaining Qualifying APM Participants status, helping providers understand not only why this status may be desirable, but also what risks they might encounter along the way.


MIPS adjustment overview

By Mary Margaret Huizinga, Pamela M. Pelizzari | 18 August 2016

This paper covers the transition from current payment programs to the Merit-Based Incentive Payment System (MIPS), reviews the MIPS inclusion criteria, discusses the Composite Performance Score (CPS), demonstrates how the CPS leads to the determination of the MIPS adjustment factor, and explores the effect of changing practices on both the CPS and MIPS adjustment factor.


Advanced APMs and Qualifying APM Participant status

By Lynn F. Dong, Pamela M. Pelizzari | 16 August 2016

This paper explores the definition of an Advanced Alternative Payment Model (Advanced APM) , how providers can qualify to be paid under the provisions of the Advanced APM track instead of under the Merit-Based Incentive Payment System, and why that might be desirable.


Key MACRA timeframes

By Mary Margaret Huizinga, Pamela M. Pelizzari, Susan E. Pantely | 03 August 2016

This paper covers the timeframes associated with the Medicare Access and CHIP Reauthorization Act of 2015 with a focus on the Merit-Based Incentive Payment System and the Advanced Alternative Payment Model.


MACRA: Key issues for providers

By Christopher Kunkel, Colleen Norris, Lynn F. Dong | 09 August 2016

A list of five important considerations regarding the Medicare Access and CHIP Reauthorization Act of 2015 and how these may affect providers.


MACRA: Key considerations for health plans

By Colleen Norris, Mary van der Heijde | 11 July 2016

While the The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) may seem like it has little to do with health plans in the commercial, Medicare Advantage, or Medicaid space, but in reality, MACRA has broad and wide-ranging implications for other payers.


MACRA: Overview for providers

By Colleen Norris, Mary van der Heijde | 11 July 2016

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a major piece of legislation that will reshape the way in which healthcare is paid for.


Are you ready for the new world of value-based reimbursement?

By Marla Pantano | 11 July 2016

Value-based reimbursement contracting and payment can lead to long-term success if the appropriate resources are engaged.

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