As we embark on the path to value-based care, we have many reasons to be optimistic about the future of healthcare. The benefits include a fresh perspective on patient data, new avenues for provider-payer collaboration, and the prioritization of the quality of care over the number of patients entering a health
system.
Healthcare providers across the country are wrapping up their first performance year under the Medicare Access and CHIP Reauthorization Act (MACRA). Any reported metrics this year will make themselves known in 2019, affecting reimbursement and – more forebodingly – the penalties providers
will experience. However, if you are a healthcare provider still trying to get a clear grasp of the program’s requirements, you are not alone – nearly 75 percent of providers are not ready for MACRA or need help.
Behavioral Health, Interoperability and eConsent: Meeting the Demands of CMS Final Rule Compliance
In a webinar on April 16 at 1pm ET, Aneesh Chopra will moderate a discussion with executives from DocuSign, Velatura, and behavioral health providers on eConsent, health information exchange and compliance with the CMS Final Rule on interoperability.
While some struggle with the organizational shifts needed to facilitate compliance, many are simply unfamiliar with the ins and outs of the law and its potential impact. When 2018 arrives, these health care providers
must hit the ground running, prepared for the performance categories they are required to report. MACRA is rewriting the rulebook on how we think about and pay for patient care, laying the groundwork for a future in which the abundance of patient data at our disposal is meaningful and actionable. It is
critical that all stakeholders involved – from healthcare organization leaders to the patient-facing providers – feel confident practicing under this new model, so that they may start adjusting their workflows and make appropriate care decisions.
Why does the industry feel unprepared and how can we fix it?
Health care providers are struggling to get up to speed, but we certainly cannot blame a lack of warning or information. In the time since the original passage of MACRA, the federal government has supplied a variety of dense guidelines and manuscripts. However, the challenge comes in properly digesting, disseminating, understanding and acting upon this information.
Individual physicians on the front lines of patient care are the true drivers of change with the hundreds of care decisions they make on a daily basis. That said, it can be difficult to make sure the most relevant information reaches them, and that they understand how MACRA’s reimbursement affects their personal practice. Making the move to value-based care requires significant cultural change within an organization. By creating open lines of ongoing communication early on, health systems can spend less time educating and more time strategizing.
Once health care providers have a solid understanding of MACRA and its potential impact, it is important to develop a strategy and be mindful of the path that will have the greatest impact. Which sectors of the patient population are most important to measure? What quality within that sector will you measure? How will you report this data? By getting organized and setting realistic goals, health systems may discover hidden opportunities for cost savings and quality improvement in the process, or confront a shortcoming that they previously avoided dealing with.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
During this transition, health care providers may face a difficult question: who will pay for and conduct this additional data collection and quality reporting? MACRA’s added administrative burden and costs can be a serious concern. The electronic health systems (EHRs) that they rely on to support data reporting may not be adequate, according to a recent industry report.
However, one valuable consequence of MACRA’s passage is resounding industry pressure for improved use of technology. Achieving the goal of higher quality, more affordable healthcare will depend on reliable technology to lift the burden of gathering, analyzing and sharing key patient data. Adoption of the right tools will
ultimately result in more informed and less overwhelmed care teams in the face of large-scale structural change.
Looking at healthcare through a different lens
Despite the inevitable time and effort, it takes to incorporate these changes into one’s practice, it is important for all involved to see the light at the end of the tunnel: more integrated care and improved patient outcomes. Despite this period of trial and error — which admittedly can be frustrating — we are shifting away from a fee-for-service world because it has proved to be unsustainable.
By taking aim at high volume, expensive care, MACRA will play multiple roles. It will work to expose more cost-effective and efficient ways to deliver care, identify holes in patient data that health care providers may have been unaware of, act as a roadmap to develop strong patient engagement strategies, and create a
benchmark from which to grow.
For decades, the industry struggled to define patient care qualitatively. With MACRA as the toolbox, we can now examine discrete episodes of care and determine their value in a meaningful way. In this age of healthcare consumerization, patients have more influence than ever on the process of individual care – and with MACRA, the industry is poised to change the lens by which we view patient health. Providers and patients alike will reap the reward of an organized game plan in a new world of value-based care.
