Making Sense of MACRA

August 11, 2016   |  Tags: Blog   |  Tags: Cost , CMS , Payment Reform
Meredith Roberts Tomasi

As a member of the Network for Regional Health Improvement, Oregon Health Care Quality Corporation (Q Corp) is committed to helping community partners stay up-to-date on the latest health care transformation developments.  The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 is just one such topic related to accelerating value-based care and payment. Q Corp is committed to helping Oregon practices and clinicians be successful in this fast evolving world.

Currently MACRA’s Quality Payment Program implementation date is mere months away (although there are petitions to delay by 6 to 12 months). Nonetheless, with 962 pages of draft rules to unravel – knowing what you need has never been more important. Those 962 pages are important. But they don’t all apply to everyone. That’s where organizations like Q Corp come in.

As an organization working with practice leaders – the administrators, managers and medical directors tasked with running the day-to-day operations of a busy medical practice – we know you are responsible for identifying and implementing practice-wide change. And as such, you need to make sense of the MACRA rules, be aware of the challenges of implementation, and identify and seize upon the opportunities the law affords. But at its core, MACRA is about advancing better care, better health and lower costs for populations of patients.  So in the midst of all the details (i.e., “the trees”) we will help you not lose sight of the forest.  Plus we connect with other stakeholders in Oregon (e.g., employers, health plans, consumers, etc.) who can be supportive. Granted, the rules aren’t yet final. But they will be – in a matter of months. And in medical practices, where it’s been demonstrated that changes take as many as 18 years (you read that right) to become fully integrated, it’s important to get started now.

Here’s how:

  1. Educate yourself. Learn as much about MACRA as you can. The Network for Regional Healthcare Improvement, the American Medical Association, the American Academy of Family Physicians, and CMS all offer valuable MACRA resources, including webinars, checklists, and blog posts.
  2. Engage fellow providers and clinic staff. If you don’t have everyone on board, it’s tough to move forward. The practices that perform the best are those who engage their entire team in the process. With MACRA, work with the concept of developing a cascading communication plan starting at the highest level, all the way through the practice to the front line.  Help clinics understand what their path will be – will they be in MIPs or Advanced APM? There are essentially two paths for Quality Payment Program:  the Merit-based Incentive Payment System (MIPS) or the Alternative Payment Model (APM), which requires the Advanced Alternative Payment Model (AAPM). We know there are relatively few options to qualify for AAPM, including having enough patients to qualify; it is expected that most providers will be in MIPS.  More to come on MIPS and APMs.
  3. Understand in a deep way how you are performing on access, quality, patient experience, and per capita costs of care. Where are the places you shine, and where are places for improvement that will have the greatest impact on value?  How do you incorporate patient and family voices to engage them in what they need to manage health and costs?

We look forward to working with you so the care and health patients and families need is care that is feasible and sustainable for you to provide!  If you have any questions, please contact us at info@q-corp.org.

Meredith Roberts Tomasi is a program director for Q Corp’s Cost of Care and Payment Reform programs. Prior to joining Q Corp, she was an administrative fellow and manager of clinical planning at the Dana-Farber Cancer Institute in Boston. Earlier in her career, she worked in the employee benefits arena for six years as a benefits manager for a large self-insured employer and as a Consultant.  Meredith holds a Bachelor Degree in Psychology from Wesleyan University and a Masters Degree in Health Policy and Management from the Harvard School of Public Health.  She is an active volunteer with Kaiser Permanente’s hospice program, serves on various alumni committees, and is learning Spanish. Meredith, her husband Anthony, and their two cats moved from Boston to Portland in late 2012.  Since then, Meredith has fallen in love with the northwest, and spends her free time canoeing, camping, playing board games, and enjoying local food and drink.