Aligning MACRA payment model development with CMMI priorities
Congress has passed legislation and the Department of Health & Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), has launched programs to drive incentives for adoption of Alternative Payment Models (APMs) for Medicare and other federal healthcare programs, to align healthcare provider and program interests to achieve better healthcare outcomes at a more sustainable cost. Medicare providers are being incentivized to embrace risk-based APMs; however, due to the limited number of these APMs operating across the country, only a small minority of Medicare clinicians have the attributes or opportunity to participate in these value-based care models. It is not clear whether this condition can or will change given the current trajectory of model development, which raises serious questions about whether the incentives and existing models are sufficiently aligned to achieve the policy outcomes intended by Congress and HHS.
This paper explores the evolution of APMs since the passage of MACRA, examines barriers to new APM development and adoption, and raises questions about the limits of future APM proliferation.