Coordination, Interoperability Key for MACRA Requirements

May 25, 2016 - Last month, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will essentially drop meaningful use requirements in favor of the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). When it comes to health information technology, MACRA requirements are meant to position IT tools to create a more coordinated and connected healthcare delivery system.

MACRA requirements will relate directly toward improving interoperability between medical facilities, hospitals, and insurance companies. CMS has stated that it will look to bring more patient-centered care and connectivity when helping providers implement MACRA requirements.

These new models of payment will be centered around value-based care reimbursement. To garner more information about MACRA requirements, alternative payment models, and the Merit-based Incentive Payment System, HealthPayerIntelligence.com interviewed Richard F. Bajner, Jr. and Jimmy W. Burnett, Managing Directors at Navigant.

MACRA legislation and the move away from meaningful use

At this point in time, commercial payers are working with providers to see how they are going to meet MACRA requirements, Burnett explained.

“The final rules are not totally done yet. Ensuring clarity around how it’s going to be measured is going to be critical,” Burnett continued. “For providers, they will need to be at top of their game. This means they will have to have cost in line, their quality measures in place, and be measured timely.”

“Their EMRs will need to be fully functional so that they can record and measure the data. There’s a lot of pressure right now on the provider community to step up and be ready as this new payment mechanism goes into effect.”

Bajner discussed the different components of MACRA requirements including MIPS and alternative payment models. It is vital to have greater alignment between Medicare, commercial payers, and hospitals or clinics in order to succeed under these new payment methodologies.

“Under MACRA, there are two components: the MIPS component and the APM component. Under MIPS, there are several different measures to evaluate. As more physician groups are looking at MIPS, they’re considering how to move more of their revenue at risk so that they can implement alternative payment models.”

“I think the payers can align with physician groups and healthcare organizations when these groups are considering alternative payment methodologies,” he continued. “This goes beyond the Medicare space to include commercial payment models so that there is economic alignment across all lines of business.”

“Commercial payers have an important role in helping drive such alignment as Medicare is moving its payment systems,” Bajner continued. “Therefore, physician groups cannot say that they have one foot in fee-for-service and one foot in value; they need to have both feet in fee-for-value. That could help accelerate movement for physician groups.”

Top challenges of transitioning to MIPS, value-based care

Bajner also mentioned how transitioning to value-based payments has several different challenges such as the need to strengthen population health management and track patient health across the continuum of care.

“The most complicated and difficult parts of moving to value-based payment include being able to manage care across the continuum or across populations,” Bajner began. “This includes tracking the patient and handing off the patient from setting A to setting B.”

“Another challenge is effectively capturing data to demonstrate the level of performance that you deliver. It’s one thing to say you’re doing well and another thing to have data say it for you.”

Another potential obstacle that payers and providers will need to overcome in order to function effectively in the new healthcare payment landscape is to have greater “alignment in high-performing healthcare organizations,” Bajner said.

“We’ve got tons of data out there, but it is not easy to extract. So it’s going to be a huge change in the way we practice,” Burnett mentioned. “Even in progressive systems, they’ve set up their information platforms so that they don’t share information across the whole enterprise.”

Hospital systems and health insurance companies will need to begin implementing more interoperable technologies and sharing data in order to meet the performance measures of MIPS and APMs.

“The smarter ones are in the process of changing that. In most cases, that’s a complete re-write or a new install,” Burnett stated. “The network has to open up so that you can bring in your independent physicians who are in your clinical-integrated network. The patient is moving through the whole continuum and not just stopping in one place, so that is going to affect payment.”

“I’m not sure a lot of folks out there who are ready to do that,” he continued. “I believe there are healthcare systems are seeing the need to get on this bandwagon. Data will be absolutely critical.”

Communication and interoperability will be essential

It is clear that communicating and sharing data across the entire healthcare spectrum will be essential to succeed in the new healthcare payment landscape. Whether that means implementing new IT tools or developing new strategies for care management between medical teams, providers and payers will need to bring coordination and interoperability to the table.

“There is going to be an opportunity for payers to help enable provider care model transformation by providing more information electronically back to the provider to inform improvement opportunities to manage populations and ongoing reports to monitor progress,” Bajner clarified. “It’s critical that healthcare systems have access to the necessary information to build capabilities and utilize tools to understand the impacts of redesign on improving quality of care."

Dig Deeper:

How MACRA Affects Future of Healthcare Payment Models

MACRA’s Merit-Based Incentive Payment System Removes SGR Flaws