Synchronizing Medicare Advantage And ACOs To Support The Secretary’s Quality And Value Payment Goals

In January 2015, Department of Health and Human Services Secretary Sylvia Burwell announced the Department will tie an increasing percentage of Medicare reimbursement to quality or value. While unanticipated, the announcement was not surprising, since paying for value over volume has been long overdue. Between 2014 and 2018, the Department’s goal is to increase from 20 to 50 percent quality and value-based reimbursements made through Alternative Payment Models (APMs) such as Accountable Care Organizations (ACOs) and bundled payment arrangements. Including other initiatives such as the hospital value-based and hospital re-admissions reduction payment incentives, the Department’s goal is to tie 90 percent of payments to quality or value by 2018. The Secretary’s announcement was widely, if not universally, applauded. The Secretary’s goals, however, apply only to traditional or fee-for-service (FFS) Medicare payments. Payments to Medicare Advantage (MA) plans are excluded. That is, these goals ignore substantial and rapidly growing MA spending. Medicare Advantage plans, expected to double their enrollment to 22 million beneficiaries between 2010 and 2020, currently account for nearly 17 million, or 31 percent, of all Medicare beneficiaries and for approximately 26 percent of all Medicare payments, or $164 billion. The exclusion of MA raises three fundamental and inter-related questions about the Medicare program that, surprisingly, have received little att...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Costs and Spending Featured Hospitals Medicare Organization and Delivery Payment Policy Population Health ACOs Alternative Payment Models Catalyst for Payment Reform fee-for-service MACRA Medicare Advantage value based care Source Type: blogs