The URAC Report

Commenting on the imminent release of a final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt anticipated this new healthcare policy will give providers a “proliferation of opportunities.”

The final MACRA rule is expected to be released by CMS on or about November 1. It will implement the Quality Payment Program (QPP) that will replace the Sustainable Growth Rate governing Medicare reimbursements for providers treating Medicare beneficiaries. The QPP promotes value-based, coordinated care over the traditional fee-for-service method. It requires that participating practices cite progress through measures of performance.

With nearly two-thirds of Americans under the age of 65 covered by private insurance, no innovation in health care delivery can succeed without the support of health plans and employers. That’s why it’s not enough for the Centers for Medicare & Medicaid Services (CMS) to get behind the value-based reimbursement model; private payers need to get on board as well. 

“To effect change in health care, you can’t do anything without employers and commercial insurers,” said Aaron Turner-Phifer, URAC’s director of government relations. “To have an actual long-term, coherent, seamless health care strategy, you need commercial insurers, private insurers and private employers working hand-in-hand with the things government is trying to do.”

While most healthcare providers agree the move toward fee-for-value is a positive advance for the healthcare industry, this shift away from fee-for-service isn’t coming without its challenges.

That’s especially true for providers who serve patients in rural and underserved areas and now must implement changes dictated by the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA.