Payers can help make MACRA less painful for providers


The final rule implementing the Medicare Access and CHIP Reauthorization Act has drawn perhaps the strongest reactions from the healthcare provider community, but MACRA also has major implications for private health insurers.

The MACRA rule will implement a new, value-based Medicare payment system for more than 600,000 clinicians across the country beginning Jan. 1. The complexity of the nearly 2,400-page final rule already has one expert predicting that implementing the updated regulations will be a “nightmare.”

Yet payers can play a role in making the adjustment easier for providers in their networks--and their own companies, according to HealthPayerIntelligence. To do so, first they must move away from fee-for-service payment models and the patchwork of value-based reimbursement arrangements they currently have, which place high administrative and reporting burdens on providers.


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Instead, private payers should follow the Centers for Medicare & Medicaid Services’ lead in terms of MACRA implementation and value-based care alignment, Farzad Mostashari, M.D., founder of Aledade Inc. and former National Coordinator for Health IT, told the publication. In order to ease concerns about MACRA’s burden on smaller practices, CMS took pains to make reporting requirements easier for providers, he said.

“I would strongly suggest that private payers institute more predictable processes and requirements as well as boilerplate contracts that are based off of CMS templates and a clear process for how organizations can apply for and get those risk, value-based contracts,” Mostashari said.

In March, the Department of Health and Human Services indicated it had met its goal of tying 30 percent of Medicare payments to alternative models earlier than its target of doing so by the end of 2016. And a recent report from the Health Care Payment Learning & Action Network indicated that nearly 25 percent of payments made by health insurers in 2016 were tied to alternative payment models.

But while Medicare Advantage plans have led the way in aligning reimbursement with value, they won’t initially qualify under MACRA’s advanced alternative payment model--a fact that America’s Health Insurance Plans has protested.

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