Insurers, providers hail Medicare Advantage alternative payment model demonstration project

The Trump administration has good news for those who want Medicare Advantage contracts to qualify as advanced alternative payment models under the Medicare Access and CHIP Reauthorization Act.

Through its newly released final rule on the Quality Payment Program, the Centers for Medicare & Medicaid Services said it intends to develop a demonstration project that will test the effects of allowing clinicians to receive credit for financial risk-based arrangements with Medicare Advantage plans “prior to 2019 and through 2024.”

RELATED: CMS unveils final MACRA implementation rule: 10 changes to the Quality Payment Program

Under a previously issued final rule, CMS said it would not allow Medicare Advantage plans to qualify as advanced APMs until the 2021 payment adjustment year.

The Trump administration’s decision to speed up that process pleased insurers and providers alike.

CAPG, an association that represents physician organizations practicing capitated care, hailed the final rule, noting that a broad stakeholder coalition—as well as members of Congress—had called on CMS to find a way to count Medicare Advantage risk contracts as advanced APMs under MACRA.

RELATED: More providers urge the government to count Medicare Advantage under MACRA

“We look forward to working with CMS to design and implement this demonstration in a timely fashion,” Donald H. Crane, CAPG’s president and CEO, said in a statement.

For its part, America’s Health Insurance Plans said in an August comment letter on CMS’ proposed rule that it strongly supports such a demonstration.

“A voluntary demonstration under Section 1115A authority testing APMs in MA would further encourage providers to move away from volume-based payments toward risk-based contracts and help meet CMS’ stated goals of moving more providers toward value-based payment arrangements,” the trade group wrote.

The Better Medicare Alliance, a pro-MA group, added yet another voice to those in the industry that applauded the decision.

In a statement, President and CEO Allyson Schwartz said the group is “very pleased” that the MACRA final rule recognized the considerable role of Medicare Advantage—which now comprises one third of Medicare enrollees—in accelerating value-based provider contracting.

In addition to the inclusion of the MA demonstration project, CMS' final rule includes other technical changes that it said are meant to ease the burden on physicians as they transition into the Quality Payment Program. They include giving up to five bonus points on the final score for treatment of complex patients, and helping small, rural practices band together to share the responsibility of participating in value-based payment.