Transformation Rx Vlog: MACRA Status Check – Spring 2017

The Transformation Rx Vlog provides perspectives on efforts to improve the quality and affordability of healthcare from Elizabeth Mitchell, President and CEO of the Network for Regional Healthcare Improvement, and other healthcare leaders . Click the video link below to view the content.

MACRA Status Check – Spring 2017

By Elizabeth Mitchell, President and CEO, NRHI

Implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has been underway since January 1, 2017. NRHI member organizations and partners are supporting every day efforts by providers, employers, health plans, patients, and policymakers across the country to improve the quality and affordability of healthcare. The Medicare Access and CHIP Reauthorization Act of 2015 – or MACRA – provides a new policy landscape in which to do this work. At its core, MACRA shifts the industry’s focus from volume to value, by creating incentives to to provide care that is more affordable, and improves outcomes for patients – and ultimately entire communities.

MACRA accelerates efforts to make healthcare affordable and accessible.

MACRA shifts the way health care and services are paid for, and provides incentives for higher quality at lower costs. As the law focuses on Medicare – the largest purchaser of healthcare in the world –  it impacts the entire U.S. healthcare system. It is a long-awaited shift toward population-based health supported by population-based payment. NRHI members are working to align all stakeholders so that everyone can understand the system change and be successful in the new environment. This includes employers as private purchasers, patients who need to engage as partners in their own healthcare, and advocates for better quality and affordability.

Six months into the first MACRA performance year, many stakeholders are actively embracing the necessary changes to succeed.

The shifts under MACRA toward higher quality and greater affordability are changing the fundamental structure of our healthcare system. They will take a lot of time, a lot of work and some trial and error. But they are moving forward. In every region where NRHI member organizations are active, there are practices that are changing the way they work and leading the necessary care transformation. There are practices that are aggressively identifying new sources of data and information to help them manage their populations, and implementing team-based and other innovative approaches to care that align with this new direction and payment system.

2017 is the MACRA “transition year.” Practices should start participating now if they haven’t already.

In 2019, The Centers for Medicare & Medicaid Services (CMS), which administers Medicare and oversees MACRA implementation, will provide payment based on performance in 2017. It is therefore critical for providers to understand the MACRA framework, where their practice, operations and services stand now, and what they need to change to succeed under the new system. Any data submitted in 2017 will help improve their score and therefore their reimbursement in 2019.

CMS has made it easier for practices to start participating in 2017. What practices learn now will prepare them well for what will ultimately be tougher performance requirements in the years ahead.

In 2017, most providers will be subject to the Merit-Based Incentive Payment System (MIPS). They will not qualify as other alternative payment models (APMs). This means, in 2017, providers need to report at least some data on quality, clinical practice improvement, and how they are sharing information. Ultimately practices will also have to report cost and resource use.

Tools and resources for success.

There are resources available that can greatly increase stakeholders’ chances for success under MACRA. Three in particular stand out:

  • CMS offers a fantastic website, https://qpp.cms.gov/. It offers a wide array of resources and tools to get stakeholders started and continually enhance their participation levels.
  • The Physician Physician-Focused Payment Model Technical Advisory Committee (PTAC), which reviews proposals and makes recommendations to the Secretary of the Department of Health and Human Services on which proposals to approve, has a website that offers a wide variety of tools and resources to assist practices in formulating proposals and submitting them for consideration.
  • The Quality Payment Program for Small, Underserved, & Rural Support (QPP-SURS) program was established to enable local, experienced organizations to provide technical assistance and support to eligible individual or small group practices of 15 or fewer during the MACRA transition. NRHI is one of 11 organizations helping to coordinate this work.

What is the one thing each major stakeholder group should focus on in the second half of 2017?

 No one can fix the payment and delivery system on their own. This is going to require aligned work by providers, employers, health plans, patients, and state and federal government.

  • Employers and other payers need to work with providers to understand what is being asked of provider partners, and how they can align efforts for quality services and payment.
  • Providers need to coordinate their efforts with other stakeholders and CMS to ensure success.
  • Health plans need to work with providers, payers, and patients to determine appropriate benefits and payment.
  • Patients need to be engaged in their own health and use their collective voice to demand quality services at affordable prices.

Overall, NRHI is seeing significant evidence across the country that stakeholders are taking steps to understand and engage in MACRA implementation. There is, however, much more work to be done in the second half of 2017 to enlist more regions and more communities into this effort. We can improve care and make it more affordable for average Americans by taking advantage of this critical moment in time.