Posts in Category: MACRA

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Value-based care is here to stay, will get boost from analytics, study says

Despite 2017’s cancellation of mandatory bundled payments, the value-based care movement in the United States is still healthy and will benefit in 2018 from analytics, according to a report from Washington, D.C.-based healthcare consulting firm Avalere.

In “2018 Healthcare Industry Outlook,” Avalere says new ways to collect data and advanced analytic capabilities are revitalizing efforts to turn data into insights that can inform policy and improve clinical workflows. This supports the shift to value-based care, which has continued even as the Trump administration backs away from large-scale mandatory models.

In November, the Centers for Medicare and Medicaid Services (CMS) canceled a plan for mandatory hip fracture and cardiac bundled payments that was slated to go into effect Jan. 1, sparking some concern that the action signaled a move away from value-based care. But then on Jan. 9, the CMS launched a new, voluntary bundled payment model that will be considered an alternative payment model (APM) for purposes of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) reporting.

This, along with evidence from Avalere that the private sector has not reversed course, tells us that interest in strategies to move away from the traditional fee-for-service payment model has not waned.

“Despite political transitions and revisions to Medicare bundled payment programs, the U.S. healthcare system’s transition to APMs has remained steady,” the report says. In 2017, some of the largest commercial plans were running nearly 50 percent of their medical spend through APMs and aim to go higher, according to Avalere.

Because value-based care rewards healthcare providers who prioritize better outcomes for their patients, leaders are turning to technology investments that can lower costs and improve care quality. Avalere says that data reliability and accessibility, including capturing information and creating algorithms, will drive outcomes-based contracting and a transition toward APMs.

“Success in APMs will require providers to create better infrastructure for proactive care management, data analytics, and timely integration of disparate data,” the report says. “More widespread availability of real-world data will enable new entities to leverage analytics and insight to benefit patients and their providers.”

An outcomes-driven environment requires fast and easy access to clinical and financial intelligence that can shine a light on the best possible course forward. To learn how LUMEDX data analytics can help your organization in the transition to value-based care by becoming more efficient and improving patient satisfaction, get information about the Cardiovascular Performance Program or email us at info@lumedx.com.

Early Reaction to MACRA Rule Mostly Positive 

Last weekend was a busy one for those trying to parse the new MACRA rule released on Friday. At 2,202 pages, the Medicare Access and CHIP Reauthorization Act rule wasn't exactly beach reading, and it gave the health IT community plenty to talk about on social media and in policy statements.

The dust is still settling, but it appears that early reaction to the rule was mostly positive. Healthcare organizations praised the CMS for being responsive to concerns they had raised during the comment period leading up to the rule's finalization. In fact, about 80 percent of the 2,000+ pages are comments CMS received and its responses.
The American Medical Association was pleased with the permanent elimination of the Sustainable Growth Rate (SGR) formula. "The new law," according to the AMA's press release, "gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients."
Other features that drew favorable reactions included:

  • The rule's overarching theme that improving the organization and payment models for medical care must stress quality over quantity.
  • Greater reporting flexibility for clinicians, as well as support for innovation in the delivery of care.
  • The formal adoption of a transition year during 2017, which makes major changes to the Quality Payment Program (QPP) reporting requirements, and provides a longer time frame for those transitioning to the QPP.
  • Emphasis on helping clinicians educate themselves about the rule.
  • Easing of the policy defining the Advanced Alternative Payment Model (APM), which will allow additional programs to quality.

But the rule is not without its detractors. "It's disappointing that the flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond," the Medical Group Management Association said in a policy statement.
Other organizations complained that the nominal risk standard defining the Advanced APM remains too high.

Want to know more? Healthcare Dive has a great breakdown of the rule changes you need to know. And for even more information on the new rule, click here. 
What's your take on the final MACRA rule? Share your thoughts in our comment section below.

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