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Published: August 6, 2015

How the SGR repeal will impact managed care

August 5, 2015 - Curant Health President and CEO, Patrick Dunham, in Managed Healthcare Executive - Ultimately, these new Medicare payment incentives will make it easier for managed care organizations to shift providers toward value-based payment models. "MIPS will reward providers who perform well on measures related to quality, resource use, clinical practice improvement, and use of electronic health records," Barkett says.

Lloyd expects that physicians will start to evaluate the two payment options and begin asking strategic questions, such as:

  • Should I continue working independently?
  • Should I join a larger group or look for employment at a health system?
  • Should I stay in fee-for-service or take the plunge into an alternative payment?
  • Do I have the infrastructure necessary to manage population health or does it make sense to form strategic partnerships with those that do?

"To the extent that eligible professionals begin to band together in larger groups or with hospitals, they may have more leverage with health plans to negotiate better rates—especially if they are reducing overall spending," Lloyd says.

While there's no direct effect on Medicare Advantage plans, Guterman maintains that the message sent by these provisions should encourage changes in the organization and practice of medicine that should benefit private plans.

"Providers and plans have been dealing with an environment in which policy makers say they want to move away from volume-based payment—but payment itself is still volume-based," Guterman says. "Even before MACRA was passed, there was increasing momentum in the movement away from volume-based payment. MACRA ... should increase that momentum considerably."

Patrick Dunham, CEO, Curant Health, Atlanta, who offers insight from the perspective of a medication management provider, believes that, "Paying for better outcomes is a top factor in successfully navigating the shift to value-based pay for the entire healthcare system, including payers and managed-care organizations. For decades our system has attempted to increase value by cutting costs, but you can only cut costs so much before outcomes are negatively affected."

Patrick Dunham

Patrick Dunham has served as Curant Health’s chairman, chief executive and president since co-founding the company in May of 2000. Under Patrick’s leadership, Curant Health has created an integrated care delivery model providing true patient medication management. His vast knowledge of healthcare information technology led to the creation of MedPlan™,

a highly effective electronic medical record keeping system at Curant Health. On LinkedIn

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