Specifically, CAPG proposed that CMS create a demonstration project through the Center for Medicare & Medicaid Innovation (Innovation Center) to test how Medicare Advantage (MA) risk contracts between health plans and physician groups allow participating entities to qualify as advanced alternative payment models (APMs).
"Medicare Advantage plays a critical role in advancing the value movement," said Don Crane, CAPG President and CEO. "We simply cannot succeed in transforming the delivery system if we continue to ignore MA, the option that provides high-value care to a full one-third of seniors. We are pleased that CMS has recognized the significant role MA can and does play in reforming the healthcare delivery system, and look forward to working with the agency to implement our proposed demonstration."
MACRA, the underlying statute that governs physician reimbursements and replaces the flawed Sustainable Growth Rate (SGR) formula with the QPP, includes two payment tracks – the Merit-based Incentive Payment System (MIPS) track and the Advanced APM track. MACRA incents physicians to join advanced APMs. However, to date, qualifying advanced APMs have included only a handful of models in traditional Medicare, and none in MA. CAPG's comments encourage the Administration to add MA risk bearing contracts between health plans and physician groups to the list of qualifying APMs.
The CAPG comments also applaud CMS's ongoing commitment to the value movement and encourage the agency to continue staying the course with proposals that include onramps for physician groups to succeed in MIPS and advanced APMs.
CAPG is the nation's leading professional association for accountable physician groups, composed of close to 300 medical groups and independent practice associations (IPAs) across 43 states, the District of Columbia, and Puerto Rico. CAPG members operate under a capitated, coordinated care model that is the essence of the nation's health reform movement from volume to value. Learn more at https://goo.gl/GtBGDZ.
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