0. VIEWING MACRA THROUGH A MEDICAID LENS
Darin Gordon

1. State Innovation Models Initiative: Round One Awards

2. State Innovation Models Initiative: Round Two SIM Awards

3. Medicaid-led Payment & Delivery System Reforms
Source: State Medicaid Operations Survey: Fourth Annual Survey of Medicaid Directors

4. Emerging Delivery System and Payment Reforms
Key Findings*
Over two-thirds of all state Medicaid programs (36) have at least one delivery system or payment reform initiative in place designed to improve health outcomes and constrain cost growth.
Twenty-one (21) states in FY 2016 and 25 states in FY 2017 (29 states in either year) reported adopting or expanding one or more initiatives, including patient-centered medical homes (PCMHs), Health Homes, Accountable Care Organizations (ACOs), and other initiatives to better manage the care of persons with multiple chronic conditions. Interest in Episode of Care payments also ticked upward for FY 2017 (7 states).
Seven states had Delivery System Reform Incentive Payment (DSRIP) programs in place in FY Four states reported new or expanded DSRIP programs in FY 2016 and five states reported new or expanded DSRIP programs in FY 2017.
* Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017 – NAMD, the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA)

5. Medicaid makes up a significant portion of total U.S. health spending
U.S. Health Spending by Source
More current estimates have Medicaid representing more than 17% of all US Health Care spending – just behind Medicare and just under half of the % of the private health insurance market.
Total = $2.5 trillion
NOTE: Health spending total does not include administrative spending.
SOURCE: Health expenditures: KFF calculations using 2013 NHE data from CMS, Office of the Actuary

6. Health Expenditures by Type of Service and Source Funds (2014)
From a service line perspective, you can see what % of the spend Medicaid is vs the other payers.
Medicaid's largest percentages are in "other health, residential and personal care; home health; and Nursing homes and HCBS" representing about 1/3 of the spend in these categories.

7. What is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
MACRA repeals the Sustainable Growth Rate (SGR) Formula that has determined Medicare Part B reimbursement rates for physicians and replaces it with new ways of paying for care.
Changes the way that Medicare rewards clinicians for value over volume.
Streamlines multiple quality programs under the new Merit-Based Incentive Payments System (MIPS).
Provides bonus payments for participation in eligible alternative payment models (APMs).