MACRA’s Macro Changes: Meeting the Mandates Through “Care Everywhere”
As a new year begins January 2017, MACRA, formally known as the Medicare Access and CHIP Reauthorization Act of 2015, begins its first year of performance. A set of policies from the Centers for Medicare & Medicaid Services (CMS), MACRA replaces the sustainable growth rate formula with a new method of determining Medicare provider payments. It aims to help Medicare achieve its goal of paying for value and better care through two programs, the Merit-based Incentive Payment System (MIPS) and incentive payments for alternative payment models (APMs). The law reflects the government’s continued focus on modernizing Medicare and transforming the healthcare delivery system overall.
Leading with the carrot and the stick
“MACRA’s goal is to improve care quality, reduce costs, and engage patients in being better stewards of their health,” says Will Pettinger, Vice President of Customer Development at Vivify Health, a fast-growing international digital health company. “It sets up a series of rewards and penalties, using a ‘carrot and stick’ approach for incentivizing providers to deliver higher-quality, lower-cost care.” The carrot? The potential for as much as a 9 percent gain for those who are successful in improving clinical and financial outcomes. The stick? Penalties as high as 9 percent for those who do not succeed – “a huge levy against revenues that most providers count on for their operations and bottom-line profits,” Pettinger notes. Participation and penalties in APMs aren’t restricted to care for Medicare recipients. Providers will need to meet MACRA goals for their entire patient population.
Looking toward a future of accountable care
The new payment structure, coupled with the CMS goal of tying 50 percent of payments to APM participation by the end of 2018, will likely contribute to the growth of accountable care organizations (ACOs), Pettinger says. Currently, more than 800 ACO organizations are in operation in the US, covering 28.3 million people across Medicare, Medicaid, and commercial populations. The most recent forecasts from leading industry observers predict a potential increase in ACO coverage to more than 176 million people by 2020; MACRA is expected to account for 37 million of that number.
Listening to the voice of the patient
“With MACRA, patients at last have a place at the table in determining how providers deliver care and how they get paid,” adds Dunnie Norman, Senior Vice President of Sales at Vivify Health. “Providers are scored on specific patient-focused goals, including patient access to health data and care coordination through patient engagement.” To get the most benefit from MACRA, providers will need to focus more than ever before on improving their relationships with patients.
Leveraging the power of remote care
A ready means of engaging patients and helping providers demonstrate clinical practice improvement activities – a requirement for success under MACRA – is remote patient monitoring. “These tools provide ongoing outreach to high-risk, rising-risk, and healthy patients, giving them the means to take a proactive role in their own care,” Norman says. “Because their health is actively monitored, patients know they’re getting the best care possible – in a way that is continual as opposed to episodic, and personalized as opposed to generalized.” Also, he explains, patients can access virtual visits as they need them, “a great way to encourage patients to ask questions and alert the care team to problems, averting a trip to an urgent care facility or a hospital emergency room.”
Remote patient monitoring can also help providers achieve better scores under the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey – in such areas as physician communications between visits, care coordination, and medication adherence, Norman notes. Providers can gather information more consistently, identify gaps, and deliver better care for patients along the entire health continuum, starting with care transitions – from acute care to post-acute care and into the home.
Learning from continuous surveillance
To illustrate the concept of remote care technology, Pettinger offers the analogy of preventative car maintenance. “Imagine if you didn’t have gauges on your car dashboard to let you know when your oil is running low or your engine temperature is running high. You’d be in the dark about what’s going on under the hood – and will likely end up at the mechanic’s shop, facing a broken-down car and a hefty repair bill.” Similarly, he explains, remote care functions as a dashboard for health, helping patients stay well and avoid costly trips to the “human repair shop.”
“Healthcare is rapidly moving to a system best described as ‘personal warranty care.’ As MACRA drives the industry toward value, the care-everywhere model functions as a continuous surveillance system. It’s one of the best opportunities for ACOs, and providers overall, to reinvent themselves, improve their clinical and financial outcomes, and turn their patients into meaningfully engaged customers.”