AMGA Announces Comprehensive Blueprint to Transform Medicare into a Sustainable, Patient-Centered System

Proposes Six Pillars to Modernize Decade-Old Payment Framework and Empower Patient Care

ALEXANDRIA, VA – AMGA today released the findings and recommendations of its MACRA and Value-Based Care Task Force, offering a comprehensive roadmap to transform Medicare from a patchwork of unstable policies into a predictable, sustainable reimbursement system that empowers patients and supports high-quality care delivery.  

The report, AMGA MACRA and Value-Based Care Task Force Recommendations: AMGA’s Six Pillars to Improve Care Delivery and Continue the Transition to High-Value Care, comes at a critical juncture as the Medicare Access and CHIP Reauthorization Act (MACRA) completes its first decade. Despite MACRA’s original promise to bring stability and promote value-based payment models, providers today face mounting challenges, including unstable Part B reimbursements, constantly shifting program rules, and a payment adjustment system that has fallen short of its intent. 

The Task Force was launched in 2023 in response to congressional requests for AMGA input on improving Medicare’s physician payment system, and the report addresses the fundamental disconnect between Medicare’s 1965-era reimbursement rules and the realities of modern healthcare delivery, including team-based care, digital health technologies, and coordinated treatment across multiple settings.

“After 10 years, it’s clear that MACRA’s vision hasn’t fully materialized,” said AMGA President and Chief Executive Officer Jerry Penso, MD, MBA. “AMGA members have invested tremendous time and resources to meet the law’s requirements, yet they, and even more importantly, their patients, continue to navigate an unpredictable system. This report and its recommendations chart a better path forward.”

Six Pillars for Transformational Change
The Task Force identified six foundational pillars essential for reforming MACRA and advancing high-value care:

1. Enhance Patient Engagement: Empower patients to take an active role in their healthcare decisions: Policies include eliminating cost-sharing requirements for chronic care management services, permanently removing geographic restrictions for telehealth, and mandating data sharing from commercial payers to providers to support coordinated, patient-centered care. 
2. Improve Health Outcomes: Ensure all populations receive high-quality care: Support providers’ ability to address social drivers of health, such as housing, food insecurity, and transportation, through enhanced reimbursement and community partnerships, while standardizing metrics and technology to track and improve outcomes across diverse populations.
3. Protect Patient Dignity at the End of Life: Promote compassionate care that respects patient preferences: Establish a total-cost-of-care model that reimburses providers for advance care planning conversations, expands Medicare coverage for concurrent palliative and curative treatments, and supports community education programs to encourage end-of-life discussions.
4. Remove Regulatory and Statutory Barriers: Reduce administrative burdens that impede care delivery: Reform outdated regulations that impede care delivery, including documentation and billing rules, prior authorization requirements, the three-day hospital stay requirement for skilled nursing facility care, and physician self-referral laws that prevent coordination in high-value care models.
5. Support Practices Serving Rural and Underserved Populations: Ensure equitable resources and support for all providers: Create Centers for Medicare and Medicaid Services (CMS) regional hubs to provide tailored assistance, develop scalable models with reduced risk and flexible timelines for small practices, and adopt phased approaches that allow small providers to build capacity before taking on financial risk.
6. Ensure the Long-Term Sustainability of High-Value Care: Establish a payment system that ensures long-term viability for providers: Establish baseline inflationary adjustments tied to the Medicare Economic Index, eliminate or increase budget-neutrality thresholds that disproportionately harm primary care providers, ensure risk model stability by avoiding mid-contract rule changes, and recognize Part A savings when making Part B reimbursement decisions.

Rigorous Process, Real-World Insights
The Task Force’s recommendations reflect an intensive two-year process. AMGA assembled a group of practicing physician executives from across the country who met more than 10 times over two years, totaling more than 60 hours of deliberation. Informed by their direct experiences delivering care under MACRA’s reimbursement and regulatory framework, the Task Force members examined all aspects of the care delivery reimbursement model to develop evidence-based, practical solutions.

“These recommendations aren’t theoretical or more think tank modeling. They’re grounded in the day-to-day realities our members face caring for patients,” said Scott Hines, MD, chief quality officer at Crystal Run Healthcare and chair of the AMGA MACRA and Value-Based Care Task Force. “Each pillar is intended to build a solid foundation for Medicare. But part of that new construction means knocking down outdated barriers that simply don’t make sense in a modern care delivery system. With these recommendations, we can transform Medicare from an unpredictable patchwork into a system that gives providers the stability they need and patients the coordinated, high-quality care they deserve.”

Empowering Patients Through System Reform
Central to the Task Force’s vision is a Medicare system that truly empowers patients. The recommendations are designed to remove financial barriers that prevent patients from engaging in their own care, expand access to convenient care options like telehealth, and ensure patients receive coordinated, team-based care that addresses their full range of needs, ranging from medical treatment to social factors like housing and food security.

“When we talk about high-value care, we’re really talking about patient-centered care,” Hines explained. “These reforms will help patients become active partners in their healthcare journey, receiving the right care at the right time in the right setting and without unnecessary administrative obstacles standing in the way.”

The report emphasizes that achieving these goals requires moving beyond Medicare’s current foundation, which is rooted in 1965 care delivery patterns. By modernizing regulations to reflect team-based care, digital health capabilities, and coordinated treatment across settings, Congress can create a Medicare system prepared to meet the needs of an aging population while maintaining fiscal sustainability.

Call to Action
AMGA urges Congress to use these recommendations as a blueprint for MACRA reauthorization and broader Medicare reform efforts. AMGA stands ready to work with policymakers, CMS, and other stakeholders to implement these changes and fulfill the original promise of MACRA: a stable, predictable payment system that rewards high-quality, high-value care.

“The window for meaningful reform is open right now,” said Beth Averbeck, MD, AMGA Board chair and senior medical director for primary care at HealthPartners. “Within Congress, there is a growing recognition that the current system is unsustainable, and we as providers have a unique opportunity to help build bipartisan support for policies that will benefit patients, providers, and the Medicare program itself. The time to act is now, before another decade passes and we find ourselves even further from MACRA’s—and if we’re being honest with ourselves—Medicare’s original promise.”

AMGA’s full report is available here.

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About AMGA
AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high-performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans.