Monthly Archives: June 2016

MACRA: Reporting for Quality’s Sake


Post by Brad Miller


Vice-President of Clinical Solutions, Caradigm

Now that we’ve had some time to think about the Medicare Access and CHIP Reauthorization Act (MACRA) and digest the details, a few high-level points stick out. First, it does away with Medicare’s Sustainable Growth Rate (SGR), which few physicians were in favor of due to the detrimental impact on services fees. Second, it consolidates and simplifies current reporting programs that were viewed by some as reporting for reporting’s sake– Physician Quality Reporting System (PQRS), Value-based Purchasing (VBP) and Meaningful Use (MU). For example, in the Merit-Based Incentive Payment System (MIPS) track of MACRA, providers only have to report on six measures, instead of the nine required in PQRS, and they also have greater flexibility in choosing what those six measures are. Third, and most importantly, CMS’ ultimate goal with MACRA is to move healthcare further to a system based on quality, and to accelerate the shift in how providers use technology to improve patient care and outcomes. CMS believes that based on its conversations with thousands of clinicians and patients, most providers have yet to acquire the right set of technology tools to make care and reporting more effective and coordinated.

Andy Slavitt, Acting Administrator for the CMS describes one the main drivers of MACRA:

“With many hours of observations, what became clear was that the combination of technology, regulation and measurement took time away from patients and provided nothing or little back in return. Among other things, physicians are baffled by what feels like the ‘physician data paradox.’ They are overloaded on data entry and yet rampantly under-informed. And physicians don’t understand why their computer at work doesn’t allow them to track what happens when they refer a patient to a specialist when their computer at home connects them everywhere.”[1]

So, how should providers start preparing for MACRA? The first thing they need to determine is whether they will qualify for the MIPS or Alternative Payment Model (APM) track. It can be a complicated determination because some organizations could be considering entering into programs (e.g. NextGen ACO) that would impact which track they will qualify for in the future. Next, they should assess their current ability to succeed in all of their value-based programs, including how they will meet the MIPS or APM reporting requirements in order to qualify for bonus payments. Although it feels like the proposed rule was just announced, providers should begin strategizing for MACRA now because the performance period scoring for MACRA begins in 2017.

At Caradigm, we are already working to stay ahead of MACRA. This includes evaluating and prioritizing the proposed measures in advance of the final rule. We are also collaborating with customers to understand their specific requirements and to determine if there are any synergies with their other initiatives and applications. Our overall approach is to build a data aggregation and analytic foundation that can be used to support multiple initiatives and reporting requirements. That foundation has to be robust yet nimble and efficient so organizations can scale programs and evolve rapidly to meet future iterations of requirements. We have architected our technical solutions to help technology support, rather than be a burden, on the progress of providers.

MACRA is a broad topic with lots of areas to explore and many implications for providers, so we will be discussing different parts of it regularly on this blog. If you’re interested in speaking about your quality reporting and MACRA needs further, then please send us a note here.

[1] Slavitt, Andy. “Datapalooza: MACRA, HER Reform and Working with Doctors – Not Against Them.” The Health Care Blog. May 12, 2016. Originally published: http://thehealthcareblog.com/blog/2016/05/12/datapalooza-macra-reforming-meaningful-use-and-working-with-doctors-not-against-them/

Filling The Care Management Tool Box


Post by Vicki Harter, BA, RRT


Vice President, Care Transformation

As I talk to many providers across the country about how to transform to value-based care, the conversation inevitably turns to the need for care coordination and care management. With many Centers for Medicare and Medicaid Services (CMS) initiatives including the recently announced Comprehensive Primary Care Plus program emphasizing the need for better care coordination, many providers have concluded that they need to evolve how they deliver care for high risk or at risk patients. This is both exciting and a little bit scary. The hard part is figuring out the right way to go about it given that there is no single blueprint that works for all providers.

One of the best written articles on care coordination that I’ve seen was this one written by Patti Oliver, RN, BSN and Susan Bacheller, BA.[1] I could not agree more with Oliver and Bacheller when they say there is a growing movement toward greater care coordination, as more health systems realize there are better ways to deliver care:

“From our combined experience, we both know how critically important it is to have good care coordination in any healthcare system or arrangement, including ACOs. Care coordination helps providers to form a complete picture of a patient’s overall heath and it also allows them to be able to better communicate with the patient, their family, and with each other. Care coordination also requires constant prioritization and re-prioritization of patients for effective panel management; it means applying art and science to split attention between patients with immediate needs and those ripe for preventive measures or patients we regard as healthy working adults”

Oliver and Bacheller then explored the essential functionality that care coordination software should deliver naming the following five features:

  1. Care coordination tools should be tailored to your patient population.
  2. Care coordination tools should have a single place the care coordinator can visit to get the full picture at the panel and patient levels.
  3. Care coordination tools must allow for convenient use of clinical pathways and be flexible for the care coordinator.
  4. Care coordination tools need to have strong communication features among providers to facilitate care hand-offs and to involve family/caregivers when appropriate.
  5. Care coordination tools should integrate with other systems—or at least be straightforward about their ability to do so.

These five items are solid foundational features to seek when it comes to care coordination and care management tools. Having worked closely with providers to identify their requirements for success in coordinating care across the continuum, I would also respectfully highlight a few other key areas.

Workflow automation – as most organizations are looking to scale their population health initiatives, one of the biggest challenges is how to manage large populations given constrained resources. One of the key components to look for in software is the ability to automate time-consuming manual workflows so that the care team can work more efficiently and also at top-of-license. Care management software should be able to auto-generate care plans and assign tasks based on patient answers to assessments.

Evidence-based guidelines – While flexible clinical pathways are important, so is the need to ensure consistency of care. This is especially true for more complex, co-morbid patients who often require care from a larger care team. Care management solutions should help reduce variation of care by embedding evidenced-based guidelines directly into care workflows to guide action. Tools should also be able to help identify best practices so that they can be shared throughout the care team.

Support for multiple programs – Care management technology requirements vary by program. For example, in the CMS Chronic Care Management program, providers must be able to track and report on time spent per month on core care management processes. For the Bundled Payments For Care Improvement (BPCI) program, providers need to be able to transition and track patients to post-acute care. Look for flexible care management solutions designed to support multiple programs so that you can maximize your return on investment.

As Oliver and Bacheller noted in their article, many new technology solutions for care managers are starting to appear. It can certainly be confusing given the broad range of features and different classes available (i.e. enterprise to basic). Ultimately, identifying the right solution will depend on your organization’s specific goals and the scope of what you are trying to achieve with population health. I look forward to having more conversations with providers this year about how they want to transform care.

 

 

[1] Patti Oliver, RN, BSN; and Susan Bacheller, BA. ACOs: What Every Care Coordinator Needs in Their Tool Box. American Journal of Managed Care. 9.24.15.

 

Where to Focus on Improving Chronic Disease Care


Post by Deb Leyva


Account Executive, Caradigm

Strategies for chronic disease management have to evolve because of the enormous increase in patient volume that’s expected. CMS statistics cited in this article project that the number of total people covered by Medicare will jump from 55.3 million in 2015 to 80 million by 2030.[1] Today, about 69 percent of Medicare patients have two or more chronic conditions.[2] Faced with an aging and co-morbid population, health practitioners are being pressed to identify the right strategies to prevent chronic disease and lower costs.

The challenge is knowing where to focus initial efforts. Many organizations are continuing to experiment in accountable care, however the overwhelming majority have found it difficult to lower the cost of care for a defined population. To explore this topic further, I thought it would be helpful to revisit this article by the Centers for Disease Control and Prevention (CDC) that listed four domains that providers should think about when seeking to improve chronic disease care.

Domain 1: Epidemiology and Surveillance: Gather, analyze, and disseminate data and information and conduct evaluation to inform, prioritize, deliver, and monitor programs and population health.

Domain 2: Environmental approaches that promote health and support and reinforce healthful behaviors (statewide in schools and childcare, worksites, and communities).

Domain 3: Health system interventions to improve the effective delivery and use of clinical and other preventive services in order to prevent disease, detect diseases early, and reduce or eliminate risk factors and mitigate or manage complications.

Domain 4: Strategies to improve community-clinical linkages ensuring that communities support and clinics refer patients to programs that improve management of chronic conditions. Such interventions ensure those with or at high risk for chronic diseases have access to quality community resources to best manage their conditions or disease risk.

To encapsulate these domains, the CDC is recommending care that is preventive, coordinated and engages patients. Also heavily implied in the domains is the idea that new health IT infrastructure is needed to support these changes. While I believe that these recommendations are fundamentally sound, they are broad and don’t specify where providers should focus.

Many of Caradigm’s customers choose to start with improving care coordination because of its central importance to driving population health. The importance is highlighted further because care coordination impacts all of the CDC Domains. For example, the ability to aggregate and share data (Domain 1) should be part and parcel of care coordination improvement efforts. So should increasing the use of preventive care (Domain 3) as well as the linkage with community-based organizations (Domain 4). Improving patient engagement (Domain 2) for co-morbid patients typically needs to be led by care managers through high-touch efforts involving a team of clinicians, family members and friends.

In my role with Caradigm as a customer account manager, I can tell you that it’s amazing to be in the room with a customer that has reached a consensus on their top population health priorities. For example, they may lay out the four or five specific care management workflows they want to improve first. Defining clear goals and a path to achieve them is a huge achievement in of itself. There’s no question that changing how an organization cares for the chronically ill is a long-term and highly iterative pursuit. No one has all the answers today, but focusing your efforts gives you a better chance to drive initial results and build momentum for your overall population health strategy.

[1] Sullivan, Tom. Chronic care management: Is the $50 billion market more hype than reality? HealthcareIT News. April 26, 2016.

[2] Lochner, Kimberly A ScD and Cox, Christine S, MA. Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, United States, 2010. Originally published: http://www.cdc.gov/pcd/issues/2013/12_0137.htm