Healthcare Groups ask Price to Include MA Arrangements as Advanced APMs in MACRA

Several healthcare organizations have written a letter to Department of Health & Human Services (HHS) Secretary Tom Price, M.D., requesting that more Medicare Advantage (MA) arrangements count as MACRA advanced alternative payment models.

The letter, from NCQA (National Committee for Quality Assurance), CAPG, the Healthcare Leadership Council, and others, stated that Medicare Advantage makes up a third of the enrollment in Medicare while in some countries, Medicare Advantage makes up nearly half of all Medicare enrollees.  Arguing their case, the groups wrote, “Downstream from health plans, some physicians are paid through risk-based contracts. Other physicians are paid in fee-for-service arrangements. Despite providing a higher level of care coordination and better outcomes, in many ways MA payment is on a parallel track to traditional Medicare.”

Meanwhile, they noted that studies have revealed that alternative payment models in MA deliver care that is of higher quality and lower cost than care delivered in fee-for-service based MA. In fact, a recent publication in the American Journal of Managed Care demonstrated that patients in capitated MA had a six percent higher survival rate, and were 11 percent less likely to visit the ER and 12 percent less likely to have an inpatient admission, they said.

As such, they concluded, “We call on the Administration to level the playing field and afford risk arrangements in MA the same credit under MACRA as risk arrangements in traditional Medicare.  A physician should have equal incentives to take risk in traditional Medicare FFS as in a contract with a Medicare Advantage plan. Leveling the playing field across Medicare will result in better care for patients and more equitable opportunities for physicians.”

It should be noted that Price himself has recently called on doctors to come up with ideas for alternative payment models that would qualify under MACRA. The idea, he said last month in a committee meeting, would be for doctors across the country to offer up ideas about what payment model would work better for them—particularly clinicians in rural and underserved areas.