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Medicare MIPS, MACRA & CCM: Complementary Programs on the Road to Value-based Care

The Medicare Access and CHIP Reauthorization Act (MACRA) is bipartisan legislation signed into law April 2015. Title I of MACRA is designed to accomplish several notable goals including providing new methods to incentify the shift from volume to value-based care.

Key Goals of MACRA

  • The Sustainable Growth Rate (SGR) Formula was repealed.
  • Numerous quality programs were streamlined into one called the Merit-based Incentive Payments System (MIPS).
  • Provided bonus payments for participation in eligible alternative payment models (APMs).

The Role of MIPS

On a related note, MIPS changes how CMS links physician quality and reporting. Instead of the Physician Quality Reporting Program (PQRS), the Value-based Payment Modifier, and the Medicare EHR Incentive Program, MACRA streamlines all of these quality and value programs into one: MIPS.


At the core of MACRA and MIPS, these two programs share goals with the Medicare CCM program and practices that participate in CCM today will be better prepared for the changes CMS is driving. Though the timeline may have shifted some for MACRA and MIPS, the long-term view is the same. Medical practices are expected to learn and understand the requirements to survive and profit in a risk-based medical environment.

How Can Providers Adjust for MACRA & MIPS?

But realistically, according to a recent June 2017 HealthLeaders Media survey, fewer than 1 in 4 physicians say they are prepared for MACRA requirements even though the link between CCM program success and MACRA and MIPS is documented in the industry media. Additionally, Healthcare Informatics reported that CCM awareness and participation has risen, but that many physician group leaders are still generally lacking the detailed knowledge that CCM programs support MACRA. 

To help your practice get started, the American Medical Association (AMA) has published resources on their website directly related to this topic promising to not only help practices understand MACRA, but also outline the 10 key steps to successfully implement a MIPS action plan. Further, eQHealth Solutions has a comprehensive Medicare Chronic Care Management Program including both the technology and services to help your practice get started. Download our CCM Program eQGuide to learn more.

Click Here to Learn More About Value-based Care.

Download the CCM eQGuide

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