The latest development in Medicare’s evolution toward value-based, clinician reimbursement is here. MACRA streamlines positive and negative payment adjustments within a value-based framework. MACRA’s approach to payment, through the Quality Payment Program (QPP), represents a transition from incentivizing healthcare providers for volume to rewarding them for value.
Most providers choosing to participate in the QPP will do so through the Merit-Based Incentive Payment System (MIPS), a non-risk–based program rewarding or penalizing clinicians based on clinical performance categories. Others will adopt risk-bearing pathways, selecting Advanced Alternative Payment Models (APMs), such as Next Generation Accountable Care Organizations (ACOs) or the 2-sided risk Oncology Care Model. Advanced APMs reward providers for performance on both quality and cost metrics.
Quality metrics are dominant drivers impacting change in both MIPS and Advanced APM payment models. The QPP is financially compelling providers to transform their practices for better health outcomes and smarter spending.
How will this transformation impact product adoption? In this value-based environment, pharmaceutical manufacturers will have to demonstrate and communicate strategic value in the following ways:
- Evidence that their product supports performance on quality measures relevant to their customers
- Strong health economic value propositions
- Robust “wraparound” interventions promoting better outcomes aligned with value-based contracts
To help our clients navigate MACRA and other payer marketing issues, Precision for Value has developed a dynamic presentation series—Insights to Access. Each topic presentation within the series features the knowledge and insights of our Payer Strategy Team and fosters productive discussions within your organization. Precision would be pleased to sit down with you and your team to discuss MACRA and the specific implications to your business. To learn more, please contact Kelly Wilder, EVP, Managing Partner at kelly.wilder@precisionforvalue.com or Carlos Delucca, EVP, Managing Partner at carlos.delucca@precisionforvalue.com.