In the News: October 13-19

Sg2 is dedicated to helping our clients interpret the latest news and trends in health care. Below you’ll find our analysis of this week’s key industry headlines, along with links to related Sg2 resources

MACRA Final Rule Is Out! Look Out for Sg2 Resources

The Medicare Access and CHIP Reauthorization Act (MACRA) transition officially begins on January 1, 2017. Last Friday, CMS released the MACRA Final Rule, finalizing the Quality Payment Program framework, which will tie the majority of Medicare clinicians’ payment to value. The Final Rule includes 2 avenues for clinician participation: the Merit-Based Incentive Payment System (MIPS) and the advanced Alternative Payment Models (aAPMs). While payment adjustments start in 2019, clinicians’ participation and performance in 2017 will determine whether they earn negative, neutral or positive adjustments.

Notably, the Final Rule includes a comment period, recognizing the need to evolve the program while heeding stakeholder concerns. Read this week’s Sg2 Expert Insight to learn more.

Beyond Sg2: New Analysis Shows Public Exchange Marketplace Slowdown

A recent analysis by Standard & Poor’s is projecting a flattening in the number of ACA public exchange enrollees in 2017. The authors are forecasting between 11.7 and 13.3 million individuals to sign up in 2017, compared to 12.7 million enrollees in 2016.

The public exchange market has experienced headwinds over the past few years, with accounts of consumers halting payments on their premiums and some insurers reporting financial losses. Read this recent Sg2 Letter to learn more.

CMS Reduces Administrative Burden on Clinicians to Ease aAPM Adoption

CMS is launching an 18-month pilot program to reduce medical review for certain clinicians practicing within specified advanced Alternative Payment Models (aAPMs). Following this pilot, CMS may expand this reduction in medical review to other providers and aAPMs. The ultimate goal is to reduce regulatory burden to increase physician engagement and experience in aAPMs.

At Sg2 we have been tracking the development of CMS payment models, as they continue to push providers toward value-based payment. Read this Sg2 Expert Insight to learn more.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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