Projects
Helping CMS Implement the Alternative Payment Model Track of the Quality Payment Program
2016 – 2021
Project Overview
Objective
This project provides technical support for the Quality Payment Program, a clinician payment reform effort within the CMMI portfolio. Section 1115A of the Social Security Act, as amended by Section 3021 of the Affordable Care Act, authorizes CMMI to test new health care payment and service delivery models that have the potential to lower Medicare, Medicaid, and CHIP spending, while maintaining or improving the quality of beneficiaries’ care (42 U.S.C. 1315a).
Project Motivation
The Quality Payment Program seeks to promote high value and high quality care for Medicare beneficiaries.
Partners in Progress
RTI International
Myers & Stauffer
Prepared For
U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation
Mathematica provides operational support, data analytics, and technical assistance to the Centers for Medicare & Medicaid Services (CMS) to help implement Section 101(e) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through the Center for Medicare and Medicaid Innovation (CMMI).
Each year, Mathematica and a subcontractor, RTI International, determine which alternative payment model (APM) participants are eligible for a lump-sum incentive payment equal to 5 percent of revenue from covered services from the previous year. Mathematica and RTI also determine which payment models in the CMMI portfolio are eligible APMs, prepare quality performance category scores for APM entities, and assess improvement activities within APMs. In addition, we conduct a variety of ad hoc analyses, provide monitoring reports each quarter, review Physician-Focused Payment Model proposals, and help determine special statuses for clinicians who are eligible for the Merit-Based Incentive Payment System.
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