The Medicare Access and CHIP Reauthorization Act (MACRA) is the beginning of the end of fee-for-service reimbursements. That makes MACRA worthy of payers’ attention. While it’s true that MACRA initially applies only to Medicare Part B payments, its pay-for-performance model is poised to push its way toward Medicaid, Medicare Advantage and even commercial patient populations. Health plans that recognize this reality can use MACRA as a tactic to:
Create new lines of business. Payers have stores of claims data that can potentially help providers earn performance bonuses under MACRA’s Merit-Based Incentive Payment System (MIPS). Payers can become advisors to providers, helping them maximize bonus payments. How? By identifying which measures align with their MACRA initiative strategic goals and tactical objectives.
Develop expertise in value-based reimbursements. Basing contracts and reimbursements on performance is a new discipline. Creating MACRA-related offerings enables payers to gain firsthand experience with value-based care and its impact on processes, systems and people. Payers can use this business intelligence to sharpen their value-based care strategies and offerings and identify where they need to build capabilities to implement their strategy successfully.
Build new provider relationships. Larger provider groups may choose to assume more risk for greater reward under MACRA’s advanced Alternative Payment Model (APM) program. Payers can bring their risk-sharing and data expertise to these organizations to form true partnerships while also helping other providers maximize bonuses.
With its clearly defined scope, MACRA is a tactic that forward-looking payers can deploy today to start defining new business models in a value-based industry. To get started, payers may need to invest in:
Data management capabilities.
Payers will need strong analytics and reporting capabilities to align claims data with MACRA’s performance measures and supply insights to providers and/or submit reports directly to CMS. Payers that invest here will also gain insights into provider performance across populations to use in contract negotiations and in designing value-based plans and services.
It’s vital to assess whether the organization’s IT infrastructure is flexible enough to support modern analytics and reporting systems: legacy systems often are difficult to integrate and don’t easily support efficient workflows.
Expertise and talent.
Access to a qualified workforce, from data scientists to business analysts, process experts and strategic consultants, is critical when working on a MACRA initiative to ensure a solid understanding of the organizational landscape and MACRA’s potential impact on it.
Assessing these areas in the light of offering MACRA services will also reveal what a health plan must do to adapt to value-based care in general. Partnering with providers to help them succeed under MACRA will enable payers to gather business intelligence and experience to inform a broader competitive strategy for thriving under value-based care. That’s why it’s critical payers seize the opportunity to make the most of MACRA and build a competitive head start today.
Learn more about MACRA by reading the other installments in this series: “MACRA: Marching Healthcare Toward Value-Based Care” (Part 1) and “How Providers May Maximize MACRA Benefits” (Part 2) and visit the Healthcare section of our website.
This Perspectives series was written by Octavia Costea, Cognizant’s MACRA Service Offering Leader, and Vanessa Pawlak, Cognizant’s Regulatory Compliance Service Line Leader. For more information, please contact us @ firstname.lastname@example.org.