MACRA: Medicare’s Opportunity to Finally Embrace Connected Health Technology

The nation’s healthcare system is in the middle of a major transition – one that, if done well, will have an incredible impact on the lives of millions Americans who rely on Medicare.

The $900 billion federal program provides health insurance for Americans over 65 and others who suffer from certain conditions and diseases. For a long time, Medicare has had a reputation for being bureaucratic, lethargic, wasteful, and outdated.

Further, the Center for Medicare and Medicaid Services (CMS), which administers Medicare, has been slow to incorporate advances in advanced health technology in the program. In 2014, the agency allocated barely 2 percent of its nearly $1 billion Medicare budget to support telehealth.

To address these concerns, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) last year with the goal of moving the Medicare system from one that incents “quality” over “quantity” by 2019. Now that MACRA is law, CMS must make changes to their regulations in order to meet these obligations.

In May 2016, CMS took a major step towards this goal by issuing a rulemaking proposal, which consolidated a slew of existing programs into the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Both MIPS and APMs set the criteria that determine which activities Medicare physicians are paid for, and how much.

CMS then opened up its proposal for feedback from the healthcare community. Our Connected Health Initiative, a group of companies from across the medical and tech industries, took this opportunity to provide detailed comments and suggestions. These included:

  • Updating Medicare’s 15 plus-year-old definitional restraints to “telehealth”
  • Ensuring that Medicare’s guidance to doctors on how they qualify for payment reflects the benefits of connected technologies
  • Eliminating legacy restrictions that have caused the Medicare system to use a backwards-looking approach to connected health technology in new payment models
  • Ensuring the Advancing Care Information (ACI) program – the “successor” to the Meaningful Use health IT incentive program – helps doctors incorporate patient-generated health data into their activities

These comments were reinforced by the wider stakeholder community in a letter to CMS from ACT | The App Association and more than 30 companies and organizations.

Later this year, CMS will use this input to inform final rules on MACRA implementation. While we’re pleased to provide our views to CMS, many steps remain in the regulatory process before we can be sure that Medicare will fully embrace connected health technology. We look forward to continued engagement with leaders in Congress, federal agencies, and other stakeholders as we head toward the launch of an improved system in 2019.