MACRA: Much More Than a New Scoring System

Blog /MACRA Much more than a new scoring system
NTT DATA Services MACRA blog

Just one in five practices (20 percent) with 15 physicians or fewer and approximately one in four practices (28 percent) with 16 to 50 physicians report that they are “ready to go” to meet the core requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to an exclusive survey conducted by Healthcare Informatics and SERMOS.

MACRA, which became effective at the beginning of 2017, will move the US healthcare system to a different form of care delivery, one that is significantly different from its earlier attempts at value-based care. The MACRA payment models are intended to fundamentally change the journey of healthcare organizations towards interoperable, connected care, focusing on improving population health management and care coordination through health IT in a distinct way.

Over time, MACRA’s two versions, the Merit Based Incentive Payment (MIPS) & the Alternative Payment Model (APM), will either reward, penalize or provide zero adjustment to a physician’s reimbursement. How each physician practice is affected will depend on performance and ability to demonstrate value, because the rewards will focus on providing qualitative over quantitative care.

Therefore, the clock is ticking for healthcare organizations to kick-start their thinking on the minimal data reporting need and ways to avoid any negative scoring that can largely impact their future ability to negotiate contracts and payment terms. It is the time for healthcare organizations to understand their patient populations more than ever before and plan interventions to improve outcomes and the patient experience if they are to succeed under MACRA.

MACRA’s systematic shift to value-based care demands a better recognition and management of the full care continuum, focusing on both prevention and early intervention, and using evidence-based care guidelines to ensure appropriate utilization. It also demands continuous learning and improvement using advanced quality measurement and safety initiatives. You won’t thrive in this environment using data sets that are a mile-wide but just an inch-deep, as many population health efforts do today. With increased scrutiny and material reimbursement dollars at stake, organizations will now require a hyperopic lens to view far and deep into the populations they manage.

With an understanding that all patients and physicians are not created equal, healthcare organizations need to start their MACRA transformation with a fully interoperable and multidimensional population health management strategy that packs a punch with all sources of patient-generated data integrated into clinical workflow. Systems must be capable of sharing data through open standards APIs, creating longitudinal views on both patients and providers across time and segments of care for risk stratification and advanced analytics to drill down to the patient level, digging out past events and predicting future behavior (a major determinant of cost and outcome). Physician performance – both in cost and service quality – must be fully understood. Your systems must be able to explain what is happening, what happened, why, where, when and who, as well as what will happen in the future. This will result in actionable health insights that will better manage risk flashpoints, physician engagement and care coordination through optimal steering of resources to the patients needing it the most.

In summary, MACRA isn’t just about implementing another new scoring system. It’s a noble attempt that has the potential to bring about a sea-change in the healthcare industry. Though the financial impact is not to be expected until the start of 2019, it is by no means a time to rest. It will transform the care delivery process over time and will become more defined and refined via new initiatives and phases. Whether it is changes in regulations, reimbursement and patient mix, or even funding mechanisms, organizations need to start sooner rather than later. The pragmatic early adopters with a sophisticated approach towards embracing new technologies, a robust population health management strategy and the ability to nurture clinical quality improvement will never be afraid to get paid and succeed in the “Age of MACRA.”

For further, practical advice about how to approach MACRA, read the white paper, Medicare Gets Serious About Value-based Payments: How MACRA Will Change Care Delivery.

Fecha de publicación: 11/12/2017