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

> **NIH NIH R01** · ARIZONA STATE UNIVERSITY-TEMPE CAMPUS · 2023 · $9,951

## 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MARCA repealed the sustainable growth rate formula (SGR), the system in which Medicare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 and continue to increase patient safety and
quality care and thereby, public health.

## Key facts

- **NIH application ID:** 10640699
- **Project number:** 3R01AG062823-04S1
- **Recipient organization:** ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
- **Principal Investigator:** Ellen P Green
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $9,951
- **Award type:** 3
- **Project period:** 2019-09-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10640699

## Citation

> US National Institutes of Health, RePORTER application 10640699, A Simulation Study of the Medicare Access and Chip Reauthorization Act (3R01AG062823-04S1). Retrieved via AI Analytics 2026-06-02 from https://api.ai-analytics.org/grant/nih/10640699. Licensed CC0.

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