2018 Value-Based Models, MACRA Quality Payment Program: Where are we?

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2/27/2018

Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

In 2018, value-based models will continue to define themselves despite practices’ reluctance to see the benefits.

In May 2017, a MGMA Stat poll showed 40% of physicians had negative sentiments about the shift toward value-based payment with only 11% positive.

In another MGMA Stat poll dated December 5, 2017, 45% of practices said they would see an increase in value-based reimbursement in 2018.

Centers for Medicare & Medicaid Services’ (CMS) goal for The Medicare Access and Chip Reauthorization Act of 2015 (MACRA) quality payment program (QPP) is the following:

Better care (improved outcomes)
Smarter spending (affordable care)
Healthier people and healthier communities (prevention)

The question remains: Can MACRA QPP achieve these goals? The QPP experience in 2017 showed us that many physicians had to rely on the often limited, inefficient electronic health record (EHR) technology. They found that performance measurement and value-based care reporting drained time and resources. As a result, practices were forced to hire more staff, work extra hours, reduce patient load or join a larger group. Some of these practices may face penalties in the future for performing below their peers. For most, the basic EHR alone does not provide all the tools needed for achieving and demonstrating strong performance to meet value-based care payment models.

To thrive in a value-based environment, it becomes necessary for practices to use advanced technologies to make it as easy as possible to collect, analyze, benchmark and submit data while delivering improved outcomes. In addition, integration of these data must be part of new or existing workflows.

Your practice goals to thrive in value-based models of care and reimbursement for 2018 and beyond must include:

Real-time data analytic reporting. The use of dashboards can provide real-time data analytics to help deliver actionable initiatives, such as obtaining a plan of care for patients with comorbid conditions or identifying quality benchmarks upon which providers need to improve.
Population management and registry reporting. These reporting data are important for meeting value-based “healthier people” requirements as well as monitoring patients’ health conditions for timely healthcare interventions and proactive chronic care management. Integrated data analysis and reporting support population management activities, such as tracking osteoporosis management in patients who had a fracture. Likewise, a practice can track colon cancer screening, monitor results and provide follow-up and timely referrals.
Patient activation. Patient activation is critical to improve outcomes and decrease costs over time. A patient portal is a handy tool to assist patients to become partners in their care. Patients who lack knowledge, skill and confidence (low-level of activation), however, will not appreciate and utilize the portal’s full functions. One size does not fit all when it comes to patient activation. Assisting practices in the use of patient activation survey (PAM®) and acting on the individual patient’s activation level can enhance the experience and outcomes for patients and practices.

A recent NEJM Catalyst report stated, the feeling stands Medicare QPP is considered a mixed bag of “moving in the right direction” to “deeply flawed," a feeling found to be the same in all regions of the United States.

In 2018, we will continue to see value-based payment reform moving forward at a moderate pace. Those practices, health systems and provider networks that proactively tackle population health, demonstrate the capabilities to manage the health of populations, and are accountable for the outcomes and total cost of care for those populations will be the clear winners.

CONTACT US TODAY!

MGMA Consulting can provide your practice or health system with an actionable assessment to improve your QPP reporting and workflows for ongoing success with value-based models. Call us today for practice assessment, patient activation scoring and assistance with understanding and using your CMS QRUR report.

Contact Pam at pballounelson@mgma.com for more information.

Written By

Pamela Ballou-Nelson, RN, MSPH, PhD, CMPE

Pamela Ballou-Nelson, RN, MSPH, PhD, has more than 30 years of experience in healthcare management, focusing on practice process transformation, patient-centered medical homes (PCMH), workflow analysis, quality measures, care management, population health and patient activation across the continuum of care. Nelson has worked with both provider and payer organizations to help them work toward alternative care and payment models. As clinical quality director for Adventist Health Network in Chicago, Nelson was responsible for leading physicians and hospital directors in their clinical integration process. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance with Medicaid care management programs, along with Medicaid insurance contracts and high-risk and dual-eligible patient programs. She has also trained, advised and mentored more than 80 practices in various levels of readiness, preparing them for value-based payment reform, process improvement, improved quality outcomes and increased efficiency through PCMH recognition with 2011 and 2014 standards. She has a BSN from the University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she is an NCQA 2014 PCMH certified content expert and frequently speaks on PCMH transformation for accountable care organizations and population health initiatives.