- Healthcare providers need to restructure many aspects of their organization for successful MACRA implementation, including data analytics capabilities, financial risk assumption, stakeholder partnerships, and patient engagement strategies, according to a new Network for Excellence in Health Innovation (NEHI) and Deloitte Center for Health Solutions report.
“MACRA's Quality Payment Program for physicians should be understood as a quantum leap in the transition from fee-for-service to healthcare compensated on the basis of quality and cost,” stated Susan Dentzer, NEHI CEO.
However, the survey of 31 senior healthcare industry leaders revealed key capabilities providers should have to implement MACRA. The executives agreed that healthcare organizations should focus on data analytics and sharing solutions, risk-based alternative payment model implementation, care coordination plans, and patient-centered experiences.
Robust data analytics and sharing key to MACRA implementation
Executives stated that healthcare providers need data analytics solutions that generate and develop insights across the care continuum, especially since MACRA requires organizations to report provider performance data.
However, the majority of surveyed executives questioned how to implement robust data sharing and who should have access and control of healthcare data. A major challenge is that each stakeholder controls different datasets and each has its own rules for gathering, aggregating, accessing, and governing data.
For example, providers control clinical data, while health plans have claims data, pharmacy benefit managers gather prescription drug and medication adherence data, and medical technology companies aggregate clinical monitoring data.
Executives also cited the financial burden of implementing health IT systems as another top challenge for MACRA implementation.
The report detailed five fundamental steps for healthcare providers as they improve their data analytics capabilities for MACRA implementation.
First, NEHI and Deloitte researchers advised healthcare providers to invest in health IT and data analytics tools that convert data into actionable insights. Health IT systems should be able to respond to regulatory changes and support value-based care.
Healthcare providers may need to look beyond their EHR systems since executives agreed that limited EHR interoperability and workflow integration only make the systems useful for capturing data. Data analytics and collaboration platforms may be better suited for MACRA implementation as long as they enable robust data sharing internally and with third parties.
Second, healthcare providers should partner with traditional and non-traditional stakeholders to integrate the care continuum. These partnerships will be key to increasing seamless care coordination and data sharing, which is crucial to tracking patient outcomes and healthcare costs.
Significant partnerships providers should consider is with post-acute care facilities. Since MACRA tracks patient health and cost outcomes over time or across a care episode, providers should ensure patients are discharged to the appropriate high-quality, low-cost facility.
Third, researchers suggested that healthcare providers review quality and resource use reports from the Physician Quality Reporting System (PQRS).
MACRA integrated PQRS components into its Merit-Based Incentive Payment (MIPS). Therefore, providers can use the performance reports to identify practice improvements and high-cost patients.
The quality and resource use reports may also be useful for selecting on which MIPS measures providers should report.
Fourth, healthcare providers should participate in risk-based alternative payment models to earn additional MIPS performance points and test out risk for future Advanced Alternative Payment Model participation.
Taking part in the CMS-guided alternative payment models should help providers gain access to healthcare data for performance tracking.
Finally, smaller physician groups may want to consider merging with a larger healthcare organization to gain access to health IT systems needed for MACRA implementation.
Providers want to take on more financial risk, but challenges remain
Most surveyed health system leaders expressed interest in engaging in risk-based alternative payment models, especially since participation can earn more favorable MIPS scores or the maximum value-based incentive payment under the Advanced Alternative Payment Model track.
However, they agreed that existing clinical models do not support physician needs for risk-based alternative payment model participation under MACRA.
Providers lacked actionable information on patient outcomes and their performance. Data siloes prevent providers from receiving timely, reliable, and actionable information and the “data dump” nature of existing systems make it difficult to identify critical information.
Provider organizations are also siloed. Providers typically cannot access patient outcome and healthcare cost data for specialists or post-acute care providers.
The siloed nature of provider organizations also prevents leaders from identifying clinical and cost variations within their organizations.
Additionally, executives noted that providers are not always focused on total costs of care despite MACRA’s emphasis on cost-effectiveness. As a result, accurate clinical documentation and coding may be lacking because documentation and coding are not integrated into provider workflows.
To help providers take on more financial risk for MACRA implementation, researchers made the following recommendations:
• Invest in data analytics and wrap-around health IT solutions to pinpoint high-cost patients and their utilization patterns
• Ensure bedside health IT tools allow providers to understand healthcare costs and utilization patterns and provide the appropriate clinical decision-support tools
• Update provider workflows to support accurate clinical documentation and coding, such as easier data capture, automated features that encourage documenting and coding, and additional training
• Shift management strategy to one of improvement versus achievement
• Evaluate clinician readiness for alternative payment model participation using health IT
• Modify provider compensation models to include more performance incentives
• Engage with the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to stay up-to-date on new MACRA-approved alternative payment models
• Assign work to the most appropriate staff and/or setting, such as sending expensive or complicated to physicians and those requiring more routine care to physician assistants or nurse practitioners
• Partner with specialists to track patients across care continuum and align referral policies with cost-efficient and high-quality goals
Collaboration and patient engagement necessary for MACRA implementation
Executives stated that collaboration across the organization and the industry as well as increased patient engagement activities are critical to successful MACRA implementation.
Like with data siloes, stakeholders are finding it difficult to break down organizational siloes to improve collaboration for MACRA implementation. Providers stated that they have faced obstacles with getting health plans on board with data sharing and analytics needed for more robust monitoring.
Many health plans have also resisted developing risk-based alternative payment models for providers because plan leaders did not feel their providers had the necessary volume, capital, systems, and processes in place to succeed.
In addition, some high-performing health system leaders do not see the value in MACRA. Health systems experienced with value-based reimbursement significantly reduced overall costs and may find it harder to demonstrate improvement, which is the basis for MACRA incentive payments.
To encourage more collaboration, providers should start with community-based organization outreach, researchers advised.
“Understanding the situations that affect health outcomes and engagement—housing, socioeconomic status, and even access to healthful food—can help clinicians understand some of the barriers their patients face in their treatment,” they wrote. “Engaging with community-based organizations such as churches, community centers, aging organizations, and others can help providers strengthen that understanding and engage more effectively with patients.”
Healthcare providers should also focus on improving patient engagement as MACRA implementation continues. CMS plans to publicly release MIPS performance scores, meaning MACRA performance may influence patient volumes.
“Providers may need to redesign workflow and processes to become patient-centric rather than provider-centric,” the report stated. “They also may need to invest in the mechanisms, tools, and technology necessary to better engage patients and enhance the patient experience—from making appointment scheduling easier, to increasing shared decision-making, to offering convenient payment processes and effective care follow-up.”
Providers should employ patient advocates, such as care navigators, social workers, and home health workers, to facilitate seamless care coordination and help patients move across health systems.