Holy MACRA! Thriving in a World Where Quality Is King
Year 2017 brings new beginnings to virtually every industry. For healthcare, it’s the first year of performance for the Medicare Access and Chip Reauthorization Act of 2015, better known as MACRA. As part of the shift toward value-based programs proposed by the Centers for Medicare & Medicaid Service (CMS), MACRA creates a new framework that rewards providers not for the volume of services they provide but for the value of care they deliver. As performance measures took effect January 1, providers failing to meet MACRA’s requirements will see their Medicare payments reduced by as much as 4 percent in 2019 – and as much as 9 percent by 2022.
To thrive under these challenging conditions, forward-thinking healthcare organizations are seeking fresh avenues for increasing quality of patient care and improving their bottom lines.
“The most proactive providers are treating MACRA not as a siloed strategy, but as an integrated one,” says Jeff Haggard, Vice President of Customer Development at Vivify Health, a fast-growing international digital health company. “As part of a holistic approach to MACRA, a carefully designed remote patient monitoring program can deliver positive returns – not only in patient outcomes but also in financial results.”
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Paying for quality
Quality is the focus of MACRA’s new provider payment system, the Quality Payment Program. Providers can participate in the program on one of two tracks, either the advanced alternative payment models (APMs) or the Merit-based Incentive Payment System (MIPS).
“MACRA opens the door to a new world where quality of care is king,” says Bill Paschall, Vice President of Business Development at Vivify. “To reap MACRA’s rewards and avoid its penalties, providers will need to collect key data elements that demonstrate they are delivering high-quality, patient-centered care.”
Providing the data
According to Robin Hill, RN, Vivify’s Vice President of Clinical Solutions, an effective tool for data gathering is remote care monitoring solutions using BYOD, or bring your own device. “As patients engage with their care teams, they answer questions on their personal devices that can satisfy the four MIPS performance categories: improving quality, advancing care information, enhancing clinical practice activities, and maximizing resource use.”
Clinical practice activities is an area particularly rife for advancement through remote patient monitoring, she explains. “A remote care program can help providers meet three key requirements for practice improvement: expanding practice access by providing 24/7 access to care teams; managing populations through patient education and follow-up; and coordinating care more efficiently after hospital discharge.
Preventing hospital readmissions
With MACRA’s quality care provisions, providers will feel even more pressure to improve preventable readmission rates, Paschall notes. “By managing chronically ill patient populations with remote monitoring, providers can better educate patients on health management. This can result in better outcomes for chronically ill patient populations, such as those with diabetes and hypertension, and fewer acute care and unplanned clinical visits.” Customers using the Vivify Health solution, for example, have reduced readmissions by as much as 50 percent.
Putting patients first
By creating financial incentives and penalties around patient engagement, MACRA is expected to accelerate the industry’s rapid trajectory toward a patient-centric universe.
“In the post-MACRA world, it’s no longer sufficient for physicians to visit with their patients once or twice a year,” Hill says. “They’ll need more frequent touchpoints. Remote patient monitoring provides that channel for continuous engagement.” It can lead also to higher patient satisfaction levels and increased quality scores, she notes, as patients feel more connected to their care providers and are more likely to have improved health outcomes.
Producing financial benefits
Remote care monitoring programs can directly boost the bottom line, Paschall says. “Along with preventing avoidable hospital readmissions and unplanned clinical visits by keeping patients healthy at home, providers realize tangible cost savings by eliminating travel time for clinical staff and measurably increasing the number of patients they can manage.” While providers who contact patients by phone can typically cover 20 to 25 patients per care manager, with Vivify’s fully managed kits, they can extend care to 100 patients per manager and with the BYOD solution, to 500 patients, he explains.
Many providers moving forward with MACRA requirements may benefit also from using the chronic care management (CCM) code, he adds. This reimburses an average $42 per month for non-face-to-face care for patients with two or more chronic diseases. As of the start of 2017, CMS has implemented additional codes for complex chronic care management, signifying the agency’s accelerated focus on value-based care. “Organizations with a well-defined CCM strategy will have a head start in mastering MACRA, particularly in demonstrating patient engagement and care coordination capabilities.”
Preparing for tomorrow
“We know what tomorrow will bring,” Haggard says. “The day is fast approaching when ‘care anywhere’ will be healthcare as usual.” With the start of MACRA performance measures now a reality, he explains, healthcare providers have a distinct opportunity to embrace the future – bringing real value to their organizations, and the patients they serve, by leveraging the power of digital technologies.