Document Type


Date of Degree

Spring 2017

Access Restrictions

Access restricted until 07/13/2019

Degree Name

MS (Master of Science)

Degree In

Health Management and Policy

First Advisor

Mueller, Keith J.

First Committee Member

MacKinney, Clinton

Second Committee Member

Vaughn, Thomas E.

Third Committee Member

Wright, Bradley


With the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress made changes to several important federal health programs. First, MACRA reformed the Sustainable Growth Rate, a mechanism created under the Balanced Budget Act of 1997. Second, MACRA instituted the framework for the QPP which solidifies efforts to shift payments to value-based arrangements and streamline several existing programs under a single policy.

This thesis aims to better understand how providers are responding to this new policy in four parts. First, I explain how MACRA passed in Congress with nearly unanimous bipartisan support. Second, I review the QPP and the two tracks offered under the program. Third, I review the literature on value-based payment arrangements, including the response of providers and health systems to these arrangements. Finally, I present original research on how major health systems and provider groups in the state of Iowa are preparing for MACRA implementation. I find several characteristics among health systems and provider groups that are associated with efforts to align payments to value-based measures. Across the tracks laid out under the QPP, there is consistency in the types of investments and operational changes being made. Work on these changes has been occurring for several years, and continued investment and reforms are likely.


Iowa, MACRA, Medicare, Part B, Quality Payment Program


vii, 67 pages


Includes bibliographical references (pages 64-67).


Copyright © 2017 David Thomas Nelson