The insurance industry is not pleased that the federal government’s new physician payment regulations don’t allow Medicare Advantage plans to qualify under the advanced alternative payment model (APM) for several years.
The Centers for Medicare & Medicaid Services issued its final rule in October to implement the new payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It will take effect Jan. 1, and sets 2019 as the first year of value-based provider payment bonuses.
CMS made it clear in its proposed rule that MACRA’s Quality Payment Program will be based on traditional Medicare, not Medicare Advantage. But starting in 2021, Medicare Advantage plans could qualify under the All-Payer Combination Option.
America’s Health Insurance Plans has already taken issue with that timeline, Healthcare Finance reports, stating its case in a letter sent in June to CMS Acting Administrator Andy Slavitt. To AHIP, Medicare Advantage plans quality as an APM by definition.
"Medicare Advantage plans themselves are receiving capitated payments, so they're clearly taking risk," Mark Hamelburg, senior vice president of federal programs for AHIP, told the publication. "In turn, they have risk arrangements with providers," he added.
Indeed, insurers are investing considerable resources into Medicare Advantage plans in a bid to reap more government quality bonuses. Humana, a major player in the MA market, reported this week that its value-based MA reimbursement models were associated with lower care costs and better patient outcomes.
In January, healthcare researcher and policy consultant David Introcaso, Ph.D., argued in a Health Affairs Blog post that given the rapid growth of MA plans, it is unwise to exclude MA plans from the transition to value-based payment models. He said MACRA gives the Department of Health and Human Services a chance to reimagine the Medicare program as a "coherent whole.”
At last week’s AHIP conference on Medicare, CMS Chief Medical Officer Patrick Conway seemed to agree, saying MA and traditional Medicare must be more aligned, according to Healthcare Finance. He also said the agency wants to work with insurers to design better quality measures for the Medicare Advantage space.