What MACRA Means to Medicare Advantage
This week, the HealthcareWebSummit event: MACRA
and Medicare Advantage Plans: Synergies and
Potential Opportunities, featured
Milliman's Christopher Kunkel, Lynn F. Dong and
Noah Champagne discussing how the MACRA impact
on Medicare fee for service will spill over in
Medicare Advantage land.
Here's questions the speakers told stakeholders
to consider for their situations:
will MACRA affect MA plans’ provider payments?
What synergies exist between MACRA’s quality
scoring and the MA Stars quality program?
How can MA plans help providers achieve
Qualifying Participant (QP) status?
What incentives exist under MACRA for providers
to improve risk score coding?
- How are
MA plans in the market responding to MACRA?
They addressed these potential MACRA
synergies for Medicare Advantage plans regarding
their provider networks' participation in MACRA
- Quality metrics
Advantage and CMS Advanced APMs
Medicare Advantage provider contracts
Fee schedule impacts
Regarding quality metrics,
the speakers cited a significant overlap of
metrics between MA and the APM/MIPS programs.
While providers can choose from hundreds of
metrics under MACRA, MA plans may be able to
help steer providers towards mutually
The speakers noted
that the CMS objectives for advanced APMs - MSSP
and Next Generation ACOs - are becoming more
closely aligned with Medicare Advantage program.
As such, there are risk adjustment opportunities
under Next Gen and Medicare Advantage; quality
overlap with STAR ratings, and applicable
provider care management programs can impact
MSSP, Next Gen, and Medicare Advantage
Regarding MA plan provider
contracts, the Milliman speakers predicted there
will likely be provider movement towards
Advanced APMs (All-Payer criteria for QPs). They
counseled that MA plans should review contracts
compared to Advanced APM criteria, and consider
the costs/benefits of developing, maintaining,
and administering such contracts.
What are the provider fee schedule impacts? The
speakers see pressure on Part B providers, and
providers may look for contract changes. Also,
downward pressure on FFS costs may drive down MA
capitation rates. The speakers ask stakeholders
to consider what does “FFS Medicare” mean in a
MACRA world? Do you include or exclude MIPS
adjustments and QP bonus FFS Medicare analysis?
What will be the contracting impact on
high-performing vs. low-performing providers?
The speakers emphasize the potential
opportunities this brings about for provider and
plan partnerships. Providers are increasingly
moving towards risk arrangements. and are
looking for partners that can support them with
financial protection, network considerations,
provider education and engagement, care
management, risk score improvement, quality
metric submission, and legal/regulatory issues.
The speakers counsel Medicare Plans to leverage
their resources and capabilities to meet these
For More Information:
MACRA and Medicare Advantage Plans: Synergies
and Potential Opportunities
HealthcareWebSummit, March 29, 2017