Policy Initiatives:

Medicare’s Fitful Quest for Value-Based Care

Even after MACRA’s enactment, Congress has

continued to tinker with the Quality Payment Program.

Executive Summary


This paper provides background on the enactment and implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which made significant changes to clinician payment in Medicare. It also highlights some of the shortcomings of the law and the Quality Payment Program (QPP) it created. While MACRA’s goal of moving Medicare beyond fee-for-service toward paying for value was reasonable and broadly popular, its enactment has not transformed the quality of Medicare services as promised. Instead, the QPP has prioritized centralized federal planning and measurement over the experiences of patients themselves as the primary determinants of value. Medicare’s reporting requirements and alternative payment models have not fostered quality improvement; rather, they have added burden, and the latter have also failed to deliver savings. Congress and the executive branch have been forced to make changes and exemptions to MACRA, but a long-term approach to clinician payment is needed.

The paper was authored by Paragon’s Policy Analyst, Joe Albanese. 

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