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By Meghan Cintorino • November 20, 2017

What is MACRA?

MACRA: A win for patients, clinicians, and the healthcare tech industry.

Medicare, and healthcare in general, has been a staple in news cycles in recent months. With the debate over repealing Obamacare heating up, it’s hard not to have an opinion on how our healthcare system functions.

Regardless of where you fall on the debate, there is one piece of legislation that Medicare recipients, providers, and the tech industry should be paying attention to — The Medicare Access and Chip Reauthorization act of 2015, or MACRA.

What is MACRA?

MACRA is the replacement for the Standard Growth Rate (SGR) compensation plan for Medicare providers. MACRA’s goal is to incentivize healthcare providers to focus on value-based cared over volume of cases reported for Medicare patients.

To do this, MACRA overhauled the Medicare compensation structure, combining previously confusing criteria, under the more streamlined Quality Payments Plan(QPP). Under QPP, Providers who qualify for MACRA can choose one of two paths – Merit-based Incentive Payment System (MIPs) or Alternative Payment Models (APMs). 


Providers who opt-in for MIPs will be scored on 4 metrics – Quality, Resource Use, Clinical Improvements, and Advanced Care Information. Based on their combined score, providers will receive a positive, negative, or neutral compensation adjustment, with the adjustment threshold increasing every year from 2017 to 2020.

Providers who qualify for the Alternative Payment Models (APMs) assume a higher level of risk for a potentially higher reward. APM participants can choose the plan that works best for their practices from a list of pre-defined models.

Starting in 2017, providers can take advantage of the value over volume plan to increase their bottom line. By providing quality care to their patients, rather than treating a higher number of patients physicians can use resources more efficiently, and begin to implement more streamlined processes into their day-to-day – making MACRA a win for providers.

How does it benefit patients and the healthcare ecosystem?

At its core, the MACRA legislation is built to ensure a better care experience for Medicare patients. The Centers for Medicare and Medicaid have made that mission clear by building patient engagement into the criteria for success. Under the MIPs track, 15% of a provider’s score is tied to Clinical Practice Improvement Activities, which scores on three categories – better patient engagement, care coordination, and patient safety.

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As for tech companies looking to increase their presence in the healthcare industry, multiple aspects of MACRA could create pathways to success.

To provide a better patient experience, ease of use, and be able to track their results, MACRA clinicians will need a robust technology ecosystem in place – opening the door for different types of platforms to be introduced into provider’s technology stack.

Additionally, under the Advancing Care Information criteria, which accounts for 25% of the MIPS score, physicians will get points for utilizing EHR Technology in their day-to-day practice. Part of the requirement for the EHR platforms used, is that they have open APIs, enabling connections to analytics tools and medical devices.

Essentially, the MACRA legislation is pushing the healthcare industry, an industry marked by slow technology penetration and high levels of complexity, to provide a better patient experience through tech innovation, opening the door for technology companies to fill the gaps.

If you’re interested in learning more about innovation in healthcare technology, check out our interoperability use-cases.