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.   

Related Staff

Jeff  Ballou

Jeff Ballou

Director, Health Program Improvement

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Marian V. Wrobel

Marian V. Wrobel

Associate Director, Health Program Improvement, Senior Researcher

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Genna Cohen

Genna Cohen

Researcher

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Eugene Rich

Eugene Rich

Senior Fellow; Emeritus Director of the Center on Health Care Effectiveness

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Jason Weinstock

Jason Weinstock

Principal Program Analyst

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Mary Laschober

Mary Laschober

Senior Researcher

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Angela Merrill

Angela Merrill

Senior Researcher

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