Voices from the Field

During the July 2016 MACRA Peer to Peer Seminar, NRHI talked with different stakeholders about where they and their organizations are in terms of understanding and implementing MACRA, and what they would find most helpful if they could ask anything of the Center for Medicare and Medicaid Services (CMS).

“Voices From the Field” offers, in their own words, valuable insights and a snapshot of where different regions stand with the new rules.

Bill Adams, Consumer/Consultant, Winding Road Communications, Minnesota
“We Need to Have the Patient’s Voice at the MACRA Table”

As an active member of the patient advocacy group, Baby Boomers for Balanced Health Care, Bill Adams is dedicated to establishing balanced care, or, as the group’s motto describes it, “Goldilocks health care: not too much, not too little – but just right!” By bringing the patient’s voice to local, regional and national conversations, the group works to ensure better access, affordability, understanding of one’s own health and care options and seeks to prevent overuse.

Bill raised eyebrows at the MACRA event as well as many stakeholders awareness levels when he quietly stated, “I hear you want all the players at the table and I’m not sure the patients are at the table … I don’t think patients know anything about this. The number one thing should be how is this going to improve patient care.”

Bill contributed significantly to the group’s list of Emerging Practices for Patients, which includes understanding MACRA’s potential to improve care quality and reduce costs, and read, learn and engage with providers and other community healthdoers.

To hear more of Bill’s thoughts around how CMS and other stakeholders can engage patient’s in MACRA click on the video link.

NRHI_MACRA_Bill Adams from NRHI on Vimeo.

Mike Sayama, Executive Director, Community First, Hawaii
“The federal government has to create an understandable, workable system in order for small practices to be successful under MACRA”

As Executive Director of Community First, one of NRHI’s two member Regional Health Improvement Collaboratives (RHICs) in Hawaii, and Vice President and Executive Director of Learning Health Homes at Pono Corporation, Mike Sayama works to create a sustainable health care system through payment reform, information integration, care coordination, and community engagement.

During the July MACRA Peer to Peer event, he calmly yet passionately called for an understandable, sustainable business model to allow providers to be successful under MACRA.

“When you think about it, our doctors are islands operating on islands,” is how he described the small, rural practices that are members of his RHIC. By necessity, they are innovative and flexible in terms of the care they give, interconnected with social service agencies, and closely involved in helping patients to figure out insurance coverage and affordability.

“I believe that the direction that MACRA is going is correct – value over volume,” says Sayama. “But what makes it impossible is that if they have to deal with MACRA plus other commercial plans which have different payment structures. That just creates an impossible situation for them to manage all that.”

Click the video link below to hear Sayama’s suggestions for how CMS can build a coherent business model under MACRA that is workable for providers and communities.

NRHI_MACRA_Mike Sayama_r2 from NRHI on Vimeo.

Jerry Reeves, MD, Senior Vice President, HealthInsight Nevada, New Mexico and Utah
“CMS has a responsibility to require interoperability under MACRA.”

As the Senior Vice President for HealthInsight of Nevada, New Mexico and Utah – one of four NRHI Qualified Improvement Organization (QIO) members – and a pediatric oncologist, Jerry Reeves brings a unique perspective from the intersection of provider experience and the necessity for accurate cost/quality measurement.

He strongly advocates for what he terms “interoperability” under MACRA. “What we find is that the electronic health record manufacturers don’t connect to the other electronic health records. Our purpose is to build an interface or to match the interface of all these electronic health records so the common fields like waist size or blood pressure or body mass index or various clinical measures besides the claims data all connect.”

As this would dramatically reduce duplicative reporting and documenting for providers while significantly improving patient experience and possibly health outcomes, Reeves sees it as a basic responsibility of CMS to require and enforce interoperability under MACRA.

To hear more of his thoughts on how to build interoperability into the system, click the video link below.

NRHI_MACRA_Jerry reeves_r1 from NRHI on Vimeo.

Cara Brioch, Director, Quality Improvement, Medica, Minnesota
MACRA will force more provider group consolidation and drive up the cost of healthcare.” 

Cara Brioch has witnessed constant and widespread consolidation of small practices in Minnesota during her years with Medica, a health insurance organization in Minnesota. She is calling on CMS to consider consolidation, the impact it will have on small practices in combination with MACRA, and to build in appropriate supports to enable independent providers to succeed under the new rules.

“When you are comparing a group of one thousand physicians and the data analytic skills that they are going to have as well as the quality improvement opportunities that they have versus a five doctor practice you are not comparing apples to apples,” says Brioch.

Brioch makes the case that providing data and reporting support for small practices will prevent widespread monopolies from forming while simultaneously keeping health care costs from rising.

Hear Brioch in her own words by clicking on the video link below.

NRHI_MACRA_Cara Brioch_r1 from NRHI on Vimeo.