# A Simulation Study of the Medicare Access and Chip Reauthorization Act

> **NIH NIH R01** · ARIZONA STATE UNIVERSITY-TEMPE CAMPUS · 2020 · $401,378

## Abstract

Project Summary
New financing models are a fundamental component of current changes to primary care.
On April 16th, 2015 the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
was signed into law. Title I of MARCA repealed the sustainable growth rate formula (SGR),
the system in which Medicare reimbursement fees have been determined since 1997. In
the place of the SGR, Medicare will pay health care providers through one of two Quality
Payment Programs: The Merit-based Incentive Payment System (MIPS) or the Advanced
Alternative Payment Model (APMs) by 2019. Both of the Quality Payment Programs link
provider payment to performance, which will force healthcare providers who are
reimbursed by Medicare to address outcome-based metrics within their practices. Practices
will need to determine how to best motivate their providers to achieve outcome measures
provided by the Physician Quality Reporting System (PQRS), while maintaining high quality
patient centered care. There are two underlying barriers with implementing a successful
outcome-based payment program: (i) it is unclear how new monetary incentives interact
with the fundamental drivers of provider behavior; and (ii) it is difficult to ascertain the
appropriate outcomes to incentivize. Insights into these barriers will be valuable in
informing primary care providers how to best adapt the changes in reimbursement. The
focus of this study is on a.) how different financing models for primary care affect the
delivery of high quality care; and b.) how different external supports, delivery or financing
models of primary care improve patient and/or provider satisfaction. The significance of this
study is triple-fold: First, we will provide a better understanding of the interaction between
monetary incentives and behavior, which is a key component of implementing outcome-
based payment; secondly, we will leverage the use health care simulations to isolate and
test the impact of finance reform on provider behavior; and lastly, we will build and
infrastructure to test the appropriate outcomes to incentivize is pivotal to improving quality
of care through outcome-based payment. The results of this study will produce evidence
needed to ensure healthcare policy promotes payment models designed to make
healthcare affordable continue to increase patient safety and quality care and thereby,
public health.

## Key facts

- **NIH application ID:** 10001419
- **Project number:** 5R01AG062823-02
- **Recipient organization:** ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
- **Principal Investigator:** Ellen P Green
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $401,378
- **Award type:** 5
- **Project period:** 2019-09-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10001419

## Citation

> US National Institutes of Health, RePORTER application 10001419, A Simulation Study of the Medicare Access and Chip Reauthorization Act (5R01AG062823-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10001419. Licensed CC0.

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