Organizations encourage HHS Secretary to adopt equitable incentives for Medicare Advantage advanced APMs under MACRA

As of now, the Centers for Medicare & Medicaid Services (CMS) has determined that MACRA will include traditional Medicare, but not Medicare Advantage as part of its APM track. However, starting in 2021, Medicare Advantage plans could qualify under the APM option.

The delay in having Medicare Advantage plans qualify as an advanced APM has created a plea from ten organizations asking HHS Secretary Tom Price to expand the options under MACRA for physicians and physician groups.

The organizations, which include both physicians and payers, sent a letter to Price asking him to accelerate the movement from volume to value-based payment, by accepting reasonable incentives for the physicians that are taking risks in Medicare Advantage contracts with health plans.

The final rule released last October that excluded the Medicare Advantage plans to qualify as advanced APMs for multiple years was not happily accepted by the insurance industry.

“Recognizing the advantages of alternative payment models in MA, we call on the administration to level the playing field and afford risk arrangements in MA the same credit under MACRA as risk arrangements in traditional Medicare,” the letter said.

The main objective of the letter and the organized plea is to get more physicians away from the Merit-Based Incentive Payment System (MIPS) and into advanced APMs.

“Providing APM credits for doctors participating in advanced payment models under Medicare Advantage will encourage value-based arrangements and advance the nationwide movement to reward clinicians for the value of the care they provide, rather than the volume of care,” said National Committee for Quality Assurance (NCQA) President Margaret E. O’Kane.

This petition, if granted, can help speed up the process of transforming the way physicians get reimbursed for the care they provide, taking a larger step into value-based payment models.

Along with the NCQA, other groups that signed the letter were: CAPG, Healthcare Leadership Council, America’s Health Insurance Plans, Health Care Transformation Task Force, Pacific Business Group on Health, Direct Primary Care, Alliance of Community Health Plans, National Coalition on Health Care and the Blue Cross Blue Shield Association.