Meeting MACRA's call for care coordination through better communication

Physician reaction has been mixed thus far into the inaugural reporting year for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Some clinicians have expressed concerns related to unresolved workflow issues in the transition to value-based payments. Many practices have delayed compliance efforts with the new Quality Payment Program (QPP) as they work to answer essential questions that could make or break their performance:

• Which clinical quality measures should our practice report?
• How will we compile and submit our data?
• What processes and resources will we need to support improvement initiatives?

Recent polls suggest that greater care coordination ranks high among providers’ MACRA-related challenges, second only to compiling reporting metrics. Improved care coordination is an essential component of success under the program. Enabling greater clinical communication among inter-departmental care teams and across diverse care settings will be vital to meeting care coordination goals featured prominently in the performance categories physicians will be scored on under MACRA’s Merit-Based Incentive Performance System (MIPS) reporting track.

Meeting the demands of MIPS

To avoid a negative 4% Medicare payment adjustment in 2019, MIPS-eligible providers must submit performance data in three categories for the 2017 reporting period. Two of these categories — quality and advancing care information (ACI) — respectively parallel earlier versions of the Physician Quality Reporting System (PQRS) and the EHR Incentive Program (Meaningful Use) that physicians should know.

The program’s Improvement Activities (IA) category, an area new to clinicians, is designed to reward practices that employ patient-centered approaches to achieve better, smarter and healthier care. IA measures emphasize care coordination, expanded practice access and population health initiatives, among others. CMS also plans to add a fourth category — cost — in future MIPS reporting periods. Cost is intended to replace the current physician Value-Based Payment Modifier (VBPM) by assessing quality of care in relation to Medicare spending per beneficiary and total per-capita costs. Although cost isn’t slated to factor into MIPS performance scores until the 2018 or 2019 reporting period pursuant to the outcome of the recent Proposed Rule regarding updates to the QPP, the focus on improved efficiency in healthcare is already a top priority among providers.

Both the IA and cost categories offer unique opportunities for providers to leverage improved communication to streamline collaboration practices and help reduce costs associated with care delivery. Enabled by communications platforms that help facilitate the easy exchange of patient and care protocol insights, providers can collaborate to drive informed clinical decision-making at the point of care. This is particularly useful when facilitating care transitions between providers and/or settings. By simplifying and expanding patient access to providers, a practice can boost patient satisfaction and compliance. In each use case, enhanced engagement helps drive improved outcomes. By removing roadblocks in clinical communication, providers can maximize efficiency by eliminating redundant or cumbersome workflows to save time and help drive down costs.

Specific examples of how improved communication for care coordination can enable IA under MIPS are:

Expanded practice access

• Provide 24/7 access to practitioners via call services and intelligent communications routing.
• Use alternative care models (e.g., telehealth services) to facilitate remote visits and consults.

Population health management

• Collaborate with partners and stakeholders on episodic care management to improve community health status for specific chronic conditions via secure communications.
• Provide timely information on hospitalizations, emergency department visits and other care management services requiring monitoring via automatic patient transition notifications.

Care coordination

• Offer timely communication of patient lab results via electronic access and notification.
• Implement processes for efficient care transitions via secure communications to support home health visits and care planning.
• Ensure bilateral, digital exchange of patient information with caregivers, including integrated behavioral and mental health.

Implementation strategies

Being able to facilitate timely, patient-centered collaboration, regardless of the care setting and inclusive of all care team members, can support the transition to value-based care on both MIPS and advanced alternative payment model QPP tracks. With public performance scores and reimbursement adjustments on the line, MACRA’s first-year reporting flexibilities offer physicians an ideal opportunity to get ahead of the curve as you pin down your strategy for success.

When building out your MIPS strategy, certain capabilities to look for in implementation include:

• Dynamic intelligent routing: the ability to automatically identify and provide immediate connection to the right care team member for the clinical situation at hand
• Single cloud-based architecture: the ability to extend dynamic intelligent routing across the entire patient-centered ecosystem, overcoming geographical barriers to care delivery by enabling collaboration with providers in multiple facilities and organizations across the continuum.

Practices that align clinicians dispersed across multiple care settings through improved communication technologies will enable administrator and physician stakeholders to push their patient populations to the forefront of value-based care.