Insurers Praise Medicare Advantage Alternative Payment Models Demonstration Project

November 2017 ~

Following the release of the final rule on the Quality Payment Program, CMS has announced its plans to develop a demonstration project that will test the effects of allowing clinicians to receive credit for financial risk-based arrangements with Medicare Advantage (MA) plans “prior to 2019 and through 2024.”

Insurers and providers alike are in favor of the change, as under a previously issued final rule the agency said it would not allow Medicare Advantage plans to qualify as advanced Alternative Payment Models (APMs) until the 2021 payment adjustment year.

CMS sees virtual groups as a way to spread-out and ease the reporting burden for small practices. Solo practitioners and small group practices of 10 or fewer clinicians may join virtual groups that will be scored on a combined performance for quality and cost. Clinicians are on a December 1 deadline to form virtual groups for the 2018 reporting period. Other technical changes included in the rule that seek to ease the physician burden 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.

Insurance groups, such as the America’s Health Insurance Plans (AHIP), American Medical Association (AMA) have released statements in support of the initiative and look forward to working with CMS in testing a demonstration for clinicians to receive APM credit for participating in financial risk-based arrangements with Medicare Advantage plans.

“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,” AHIP wrote in a statement.

CAPG, an association that represents physician organizations practicing capitated care, hailed the final rule. “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,

Better Medicare Alliance President and CEO, Allyson Schwartz, similarly said in a statement, 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.


Source(s): Healthcare Finance News; FierceHealthcare;