What are you looking for?
BLOGS/ SERVICES PERSPECTIVES
4/4/2017

What MACRA Means for Health Plans

Karen A. Way - NTT DATA

Karen A Way

Health Plan Analytics & Consulting Practice Lead

Karen has extensive experience in the healthcare market, from both a business operations and information technology perspective. She has built and led successful, effective teams that deliver best in class solutions to improve client satisfaction, organizational cost savings, and workplace productivity. 

Much has been written about the affect the 2015 MACRA legislation will have on providers and health systems; anything pertaining to health plans has been somewhat buried. The majority of publications that I have read have focused on the providers and health systems, but what about health plans? What is the potential impact to the health plan industry now that the first performance year for MACRA is underway? As with any new legislation or administrative rulemaking, there are both potential benefits and potential concerns with MACRA. Let’s take a look at some of the key topics for health plans I have found amongst the plethora of available MACRA documentation. One point on which all the analysts agree: collaboration is key.

MACRA Blog Post

By now, the term MACRA has been heard by most in the healthcare field. However, studies show that most providers are still not familiar with the requirements or how this 2015 federal legislation is going to affect them; health plans may also have questions or concerns.

The majority of publications that I have read have focused on the providers and health systems, but what about health plans? What is the potential impact to the health plan industry now that the first performance year for MACRA is underway?

As with any new legislation or administrative rulemaking, there are both potential benefits and potential concerns with MACRA. Let’s take a look at some of the key topics for health plans I have found amongst the plethora of available MACRA documentation.

One point on which all the analysts agree: collaboration is key. MACRA provides multiple opportunities for health plans to increase and/or improve collaboration with their provider networks. Recommendations on how health plans can accomplish this are:

Health plans should also be aware of potential impacts beyond Medicare fee-for-service (FFS), which is the initial focus of the MACRA legislation. During a round table discussion held in June 2016, participants identified the following items as having potential for broad impact:

As you can see, there are many reasons why health plans should be aware of MACRA and how it will impact them. Increasing collaboration with their provider networks is likely to be beneficial to both parties, helping to hold down healthcare costs and improve outcomes for the member/patient populations.

References:


Karen A. Way - NTT DATA

Karen A Way

Health Plan Analytics & Consulting Practice Lead

Karen has extensive experience in the healthcare market, from both a business operations and information technology perspective. She has built and led successful, effective teams that deliver best in class solutions to improve client satisfaction, organizational cost savings, and workplace productivity. 

VIEW ALL POSTS