Ready or not.

We’ve all seen it coming. Since the 114th Congress mustered a rare showing of bipartisanship to make the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) law – value-based payment has moved from theory to inevitability. And on April 29, 2016, CMS released 962 pages of rules that, after a two-month comment period and subsequent fine-tuning, will initiate a new era of value-based measurement for Medicare Part B reimbursements.

But while MACRA implementation is inevitable, its success as a means to effect broad-based change to the way the nation measures and values healthcare relies on connections – between healthcare providers, plans, payers and even consumers. And those connections will require solutions that haven’t yet been thoroughly defined – or established. Solutions involving data production and sharing. Solutions involving transparency. Solutions involving measurement that will necessarily rely on qualitative data to define qualitative concepts like “value” and “quality.”

Over the coming months, NRHI will monitor the evolving MACRA conversation from an objective perspective, reflecting the myriad concerns, analyses and inputs of our multi-stakeholder members. In this blog, and on our site, we’ll share information that will help to clarify MACRA and its impacts – while offering details on how to mitigate MACRA’s challenges, while leveraging its advantages.

So check back often. And we’ll do our best to provide a clear, neutral perspective on the information you need – before you need it.

With that, here are a few thoughts on what we’ll be considering in the days, weeks and months to come:

CMS relied on multi-stakeholder input.

In the process of developing the draft rules released at the end of April, CMS solicited – and applied – multi-stakeholder input to select priority payment measures.

The Challenge:

It’s not yet clear how stakeholders will have access to the data necessary to evaluate those measures. The well-known measurement gaps that currently exist need to be resolved in order to arrive at accurate, usable payment measures.

The Draft Rules tackle data sharing.

Since primary care physicians will be at the center of value-based measurement, data sharing will be vital in order to consolidate every aspect of each patient’s care. This will require technology that allows for easy communication from practice to practice, system to system, and even from region to region – nationwide. The rules call for simplification of data communication.

The Challenge:

True data sharing will require an enormous transition away from proprietary EDM systems that are designed to protect data – and to prevent communication among competing providers. In order for MACRA to succeed, its standards and policies will need to be adequate to compel change – often at significant expense – that could stimulate true data sharing and transparency.

The upside – and downside – of reimbursement reform.

Recognizing a longstanding consideration from purchasers’ wish lists, CMS has introduced downside risk for the first time. Under the rules, providers will be eligible for increased upside – and susceptible to downside adjustments if the measures determine their care to fall below established standards.

The Challenge:

Downside risk has never been a factor in Medicare Part B reimbursements – and the transition isn’t universally popular, both because it escalates accountability, and because it will require investments of time and technology. Fortunately, CMS has committed resources to assist with the time and technology challenges – and they’ve acknowledged that the work needs to be done locally. That focus means that regional partnerships will be critical, which will create opportunities for regional collaboratives and their stakeholders to provide support. Absent existing infrastructure to facilitate this transition, regional support is likely to prove indispensable in the coming months and years, as MACRA’s mandates assume their full force and effect.


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