To better inform regional health improvement collaboratives (RHICs) about MACRA and to explore how RHICs can support multi-stakeholders in this new environment of greater accountability for quality and cost, NRHI brought together local healthcare leaders from communities in Ohio, Maine, Minnesota, Nevada, Kentucky, California, Pennsylvania, Louisiana, Hawaii, Utah, Wisconsin, Oregon, Missouri, Colorado, Michigan, and New Mexico for this Peer-to-Peer event.
“MACRA may be more significant than the ACA in terms of its impact on our communities.”
~ Elizabeth Mitchell, NRHI President and CEO
Local Perspectives and Concerns
Participants brought local perspectives and concerns that offer a collective snapshot of where different stakeholders across the country are at this moment on understanding and implementing MACRA. Among the most discussed topics were:
- Awareness (or lack thereof) of rural physicians and small practices about the law and the impending deadlines.
“Even progressives think, ‘I’m not gonna change in 2017 because I won’t know whether I qualify under any model.” ~ Erik Muther, Managing Director Health Care Improvement Foundation, PA
- The ability of stakeholders to prepare/skill up in time and report appropriately when it is not clear which measures they will be rated against.
“The federal government has to create an understandable system. Small practices have no ability to keep track of all these measures and models.” ~ Mike Sayama, Vice President, Pono Health, HI
- The overwhelming complexity of rules around Alternative Payment Models (APMs), Merit-Based Incentive Payment System (MIPS) or an Advanced APMs.
“If we in this room don’t understand the rules, how can we help our members/stakeholders digest the information, much less report properly.” ~ Seminar participant
- Where is the patient voice in all of this and will it improve the quality and value of care?
“Physicians listen more to patients than they do to payers … but what actually pays the bills is completely separate from what patients want.” ~ Jerry Reeves, Senior Vice President, Medical Affiars, Heathlnsight NV, NM, UT
Presentations/Q & A Sessions
Presentations and Q&A sessions with Mai Pham, Chief Innovation Officer, CMMI (Centers for Medicare and Medicaid Innovation) and Kelly Cleary, Policy Analyst with Akin Gump, Strauss, Hauer & Field gave in depth information on proposed MACRA rules in key areas such as APMs, practice transformation, data measurement and reporting. These sessions also provided a critical opportunity for members and multi-stakeholders to provide feedback and address concerns directly to CMS (Center for Medicare and Medicaid Services).
“We are aware of how freaked out, worn out and powerless physicians feel. We are working to give them options to succeed.” ~Mai Pham/CMS
Tools for Stakeholders
Break-out sessions focused on identifying ways different stakeholders can educate and engage their organizations and communities. Together, participants developed tools for stakeholders to use as they implement MACRA:
MACRA Emerging Practices
lists for different stakeholder groups: patients,
providers, purchasers (e.g. employers) and payers
By the end of the event, many participants commented that they had a better understanding of the proposed rules, more confidence in how they would help their communities navigate the rules and take-home tools to guide stakeholders.