MACRA Primer—Top Takeaways from the New Medicare Physician Payment Pathways and Potential Market Impacts

Growth Opportunities for Digital Health Stakeholders as 2017 Marks the First Performance Year under MACRA

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Physicians are neck-deep in challenges, beginning from managing increased consumerism on one end to interpreting complex regulatory requirements on the other. The most recent, bipartisan-backed, Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA), marks the onset of delivery and payment reforms under Medicare. Quality Payment Program (QPP), the key initiative under MACRA, aims to provide a value-based reimbursement system, taking into account cost, quality, technology advancement, and clinical improvement aspects. However, as clinicians, vendors, and other entities gear up for the first performance year in 2017, there is a long way to go in terms of achieving the

Table of Contents

MACRA Primer—Top Takeaways from the New Medicare Physician Payment Pathways and Potential Market ImpactsExecutive SummaryResearch ScopeKey TakeawaysIntroductionMACRA Payment Pathways—MIPS, AAPM, and MIPS-APMMerit-based Incentive Payment System (MIPS)Introduction to MIPSOption 1—MIPS: Default Payment Track Under QPPOption 1—MIPS: Eligibility Criteria for 2017Option 1—MIPS: Performance Categories and WeightageOption 1—Payment Timelines Under MIPSOption 1—MIPS: Scoring Model and Payment AdjustmentsOption 1—MIPS: Performance Levels and Reporting RequirementsAdvanced Alternative Payment Model (AAPM)Introduction to AAPMOption 2—AAPM: Higher Risk Reward ModelOption 2—AAPM: Eligibility Criteria for 2017Option 2—AAPM: Models for ParticipationOption 2—AAPM: Timelines for ComplianceOption 2—AAPM: Higher PFS for Sustained ComplianceOption 3—AAPM: Threshold Set for Earning IncentivesMIPS-APM (APM Scoring Standard)Introduction to MIPS-APM (APM Scoring Standard)Option 3—MIPS-APM: Middle GroundOption 3—MIPS-APM: Eligibility Criteria for 2017Option 3—MIPS-APM: Models for ParticipationOption 3—MIPS-APM: Timelines for ComplianceOption 3—MIPS-APM: Timelines for IncentivesOption 3—MIPS-APM: Categories under APM Scoring StandardAnalysis of Potential Market Impacts of MACRAMACRA—Market ImpactsMACRA—Market ImpactsGrowth OpportunitiesGrowth Opportunities for Digital Health StakeholdersStrategic ImperativesKey Strategic ImperativesLegal DisclaimerAppendixQuick ReferenceKey Points to NoteThe Frost & Sullivan StoryThe Frost & Sullivan StoryValue Proposition: Future of Your Company & CareerGlobal PerspectiveIndustry Convergence360º Research PerspectiveImplementation ExcellenceOur Blue Ocean Strategy

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