An Overview of MACRA and Its Intersection with Medicare Advantage and Other Medicare and Medicaid Managed Care Programs

Webinar (EDT)

Helaine Fingold and Lesley Yeung, Members of the Firm, will present “An Overview of MACRA and Its Intersection with Medicare Advantage and Other Medicare and Medicaid Managed Care Programs,” a webinar hosted by the Health Plan Alliance.

Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) altered Medicare’s approach to physician payment by focusing on paying for value rather than paying for volume. The Centers for Medicare & Medicaid Services (“CMS”) is implementing the MACRA physician payment reforms through the new Medicare Part B Quality Payment Program (“QPP”). The QPP has two tracks: (1) the Merit-based Incentive Payment System or “MIPS” and (2) Advanced Alternative Payment Models (“APMs”). MIPS consolidates key components of several existing Medicare quality programs: the Physician Quality Reporting System (“PQRS”), the Value-based Payment Modifier Program (“VBM”), and the Medicare Electronic Health Record (“EHR”) into a single quality program that assesses performance across four categories: Quality, Resource Use, Clinical Practice Improvement, and Advancing Care Information. Advanced APMs provide a new approach to paying for medical care that incentivizes quality and value through care coordination.

Through this webinar, the speakers will provide an overview of the MIPS and Advanced APM programs. They will also discuss the role that Medicare Advantage and other Medicare and Medicaid managed care programs can play in future years of the QPP, and the criteria that such plans must meet to be considered an Advanced APM.

Discussion topics include:

  • Overview of physician payment reforms included in MACRA
  • A summary and comparison of the MIPS and Advanced APM tracks
  • Entities considered to be Advanced APMs
  • Program Implementation Timelines
  • Criteria for Advanced APM Status:
    • Quality Measures
    • EHR Utilization
    • Risk Arrangements
  • How can health plans support clinician success in the QPP

For more information, please contact Ms. Fingold or Ms. Yeung.