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MACRA at the market level

Research shows that MACRA will impact each geographic market and line of business in a unique way. This means that both providers and health plans will have multiple strategic decisions to consider in light of the changing market dynamics.

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MACRA will have global impact

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Payers and their members seek providers with a strong history of performance. And this performance will drive growth. Financial models point to Advanced APMs as being the most rewarding. This indicates that payer/physician/hospital alliances are likely to grow.

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MACRA affects plan operations and member experiences. Left uncoordinated, overlapping programs can compound program and provider friction, waste and redundancy. Payers can assess provider strategies and collaborate to support success.

The majority of health plan (69 percent) and hospital/health system (64 percent) decision-makers anticipate MACRA will lead to changes in their organization’s strategy.

– Optum MACRA Impacts Survey 7/2017 KLT Research
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Levers that can influence MACRA impacts

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  • When considering MACRA it is important to understand how your market and your organization match up to the market demand and the competition. Market factors include the percentage of population over age 65, the percentage who qualify for dual eligibility, the payer mix and the market's value-based care maturity. Organizational factors include coding and documentation capabilities, Star ratings, and the MA market share relative to fee-for services.
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Solving at the market level

Payers

  1. What is the Medicare Advantage member growth in my state?
  2. How will MACRA affect our other contracts or lines of business?
  3. Will MIPS score transparency impact my reputation and ability to contract with health plans?
  4. Will further adoption of value-based care place downward pressure on our MA county benchmark rates?

Providers

  1. Should we cost-shift to offset eroding Medicare FFS margins?
  2. Will MIPS score transparency impact contract negotiations?
  3. What is my projected revenues from both CMS and private payers?

 

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Providers track metrics

Measurement is the key to success. Explore developing quality data sets.

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Health plans prepare

Anticipating MACRA and Medicare Advantage impacts is key. 

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