As the largest payer of healthcare services in the United States, the Centers for Medicare and Medicaid Services (CMS) oftensets trend for healthcare delivery and reimbursement.
Over the past few years, there has been talk about Medicare reform and how to better pay for value. But we don’t always take the time to step back and appreciate what works well in Medicare and what has been emulated by other stakeholders.
For example, when Congress enacted the Average Sales Price (ASP) reimbursement methodology for Part B drugs in 2003, many commercial payers followed suit. This was with good reason: ASP is a transparent and stable metric that aligns reimbursement with market prices. Most recently, Medicare has again led the charge in adopting value-based reforms,creating ripple effects throughout the healthcare marketplace.
Four areas where we think Medicare has got it right are reimbursing physician-administered drugs, enabling beneficiary choice through Medicare Advantage, looking at total cost of care and tying payment to quality.