[Webinar] MACRA: Developing a Success Plan

MACRA is soon to be a reality. We covered how MACRA impacts physician practices and hospitals. Now it’s time to develop an action plan. Join CareSkore CEO, Jas Grewal and VP of Customer Success and Operations, Aditya Mangal in this 2nd installment of our MACRA webinar series, as we cover:

  • Readiness project plans for providers for 2016 through 2018
  • Roadmaps, milestones, tasks, and resources needed to make your path to value-based care a success

Watch now!

A Moment of Truth: Population Health Management Myths Debunked

What is population management? At its core, it is the assemblage of strategies and tactics providers use to identify, measure, and improve the health of your at-risk patient populations. And under the umbrella of population management efforts are:

  1. Predictions; predicting future risks across your populations
  2. Engagement; communicating with patients
  3. Reporting; performance and regulatory measures reporting

With population health management still in its infancy, it can be easy to misinterpret what it actually entails. To shed some light on the subject, we’ll address the most common myths around population health management, both as a strategic initiative and technology component.


1. “Population Management is a People- and Strategy-Only Initiative”

Without best-of-breed health IT, population health management can be challenging. To be successful, population management requires a uniformed effort from both a talented team—doctors, administration, IT, to operations and everything inbetween—and an ensemble of robust, clinician-centric technology. You need modern, up-to-date platforms that don’t get in between you and your patients, but instead, amplifies your workflows. Such processes include intimately knowing risk factors and what to do about them, communicating with patients even after they’ve left the premises, and in tandem, measuring all doctor-to-patient activities for actionable insights on how you can improve them.


2. “Population Management is a Software-Only Initiative”

On the other hand, software itself can’t tackle population health management alone. While population management software itself brings merit to the table, your team—in partnership with the right population health management vendor committed to helping you and your patients—guiding the reins can only be favorable towards your population health initiatives. Without one or the other (people or technology), your path to improved health and financial outcomes could be filled with uncertainty.


3. “Population Management Can Be Addressed by an EHR System Alone”

We’ve discussed how EHRs are critical to the care continuum, yet falls short on providing you complete guidance over your populations. For instance, a hospital system may have multiple EHRs that are unable to communicate, resulting in unnecessary silos for patient data. Chaos aside, providers run the risk of having critical information on a patient in one EHR, while in another is nowhere to be found. EHRs also lack the complete picture on your patient populations falling short on all the information you need (clinical, demographics, economic, behavioral, and social data for example) into one aggregated source. More importantly, EHRs don’t enable you to take action, whereas population management platforms allow you to take initiative and address any concerns across your patients. The ultimate takeaway is that providers must unify their EHR systems with a population management platform. But to clarify another myth: one system does not replace the other. Instead, they work together in parallel to further improve how you provide quality care to your patients.


4. “Population Management is Unnecessary”

With MACRA (The Medicare and CHIP Reauthorization Act) becoming a reality, measuring care quality will be more table stakes than ever before. This seed change to how providers are reimbursed is one of the many reasons providers should start thinking about population health management. It demands providers be forward-thinking, collaborative, and to be able to deeply know the health of their populations. Knowing the past and present in order to plan for the future, requires providers to include population health management as part of the equation.


What To Look For In a Population Health Management Platform

Population health management platforms are a fundamental element of the healthcare IT stack. Along with EHRs, they’re a staple for organizations when it comes to improving and measuring the health of your patients. They enable doctors to engage at-risk patients, see data in aggregate, meet reporting efforts, and ultimately help improve the health of your patients. Navigating the vendor landscape can be a challenging task, so we’ve come up with things to keep an eye out for when looking into a population management platform:


1. Does it utilize predictive modeling with internal and external data?

Data in your EHR is undoubtedly critical, yet it’s not enough to get a 360-degree view of your patients. You need patient-specific information—both internal and external—from clinical, economic, and demographic, to geographic and economic data to give you this holistic view. With a complete picture of your patient population, you can predict risks and address their leading factors across the continuum of care. When looking into a population health management platform, look into whether a vendor has the ability to utilize any and all patient data—in and outside your clinic.


2. Does it support regulatory and performance reporting capabilities?

Reporting, whether it’s performance or regulatory, is vital. Providers must be able to report on measures like clinical improvement activities and care quality. Look for a platform that allows you to easily generate actionable reports, and enables you to address those measures—care programs and patient engagement for example—without having to leave the same system.


3. Does it interrupt existing workflows and processes?

Look for ways a population management platform can complement existing workflows and processes. Can the solution communicate with existing technologies in your organization? Are you able to implement the solution without complications? Being able to get up and running should not take months (or years).


4. Does it enable personalized and automated communication?

Personalized experiences—which is what patients want—are critical. The challenge is being able to do that without hindering other parts of your organization such as optimizing your staff. You need a solution that enables personalization and automation in tandem. One that is able to connect with patients 24/7 and knows how and how often to engage. To help you oversee patients throughout the care continuum, look for a vendor that enables bi-directional communication. Personalization and automation functionalities help you get what patients need, when they need it.


5. Does ease-of-use exist?

A population health management system—or any healthcare IT—shouldn’t create barriers between you and your patients. Whether it’s usability or accessibility, today’s healthcare IT should be able to help you continue providing and improving high-quality care to your patients. End-users, managers, administrators, and patients must be able to use the solution without difficulty.


6. Does it help me and my patients through and beyond the journey to value-based care?

MACRA is soon to be a reality and value-based care is a transition you’re likely to face. With changes to how providers go about their reimbursements and care quality measurements, you’ll need to have visibility into which patients fall under fee-for-service contracts and which fall under value-based care. Look for a vendor that is dedicated to helping you through and beyond the transition to value-based care, on providing the right solution.


Deciding on a population health management platform to go with isn’t a process that’s neither easy nor quick. It’s important to think about the functions and capabilities that matter and make sure the vendor aligns with your goals. With this checklist, we hope you can find the right solution for you and your patients.


Join Us at The Value Based Health Care Congress 2016

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The Value-Based Health Care Congress is just a week away and we’re excited to announce we’ll be there, standing alongside industry veterans and learning more about the state of value-based care. Under The Value-Based Health Care Congress are 3 individual tracks for providers, each covering some of the key pillars of the landscape today:

  1. The MACRA Strategy Collaborative Summit
  1. Value-Based Network and Contract Management Summit
  1. ACO Strategy Summit

We went ahead and listed some of the conference sessions around care quality and health care IT that we’ll be looking forward to attending, and hopefully you will too. Be sure to stop by the CareSkore booth in the exhibit hall to see our Personalized Population Management™ platform, and learn how your healthcare organization can improve both clinical and financial outcomes. Without further ado, here are some of the sessions that we’re excited to see (exact times subject to change):


1. Measuring for Value – Panel Discussion

Track and Time: Main Summit, Day 1 @2:05pm

Core quality measure sets are in place and we’ve taken a significant leap forward in providing accurate, useful information on healthcare quality that can inform decisions. The next step in this transition to value-based care rests on our ability to integrate quality and resource use performance to ultimately drive better outcomes.

  • Understand the quality-spending relationship and how it promotes provider buy-in and success in risk-based contracts
  • Learn how to incorporate the patient voice to develop meaningful measures
  • Align measures across the continuum of care to reduce burden and improve efficiency


David Introcaso (@HealthcareIssue)

Helen R. Burstin (@HelenBurstin) – Sr VP, Performance Measures at National Quality Forum

Kate Goodrich – Director, Center for Clinical Standards and Quality at CMS

John S. O’Shea – Sr Fellow, Center for Health Policy Studies at The Heritage Foundation

Stephen L. Ondra (@StephenOndra) – Chief Strategy Officer at Amida Technology Solutions

Linda Walker – VP, Health Security at AARP


2. Examine the Role of Health IT in Delivery System Transformation

Track and Time: MACRA Summit, Day 2 @10:45am

Healthcare IT is undoubtedly a critical piece to how we advance quality and value. ONC’s Elise Anthony gives us the catch-all on healthcare technologies—from flow of health info to patient data access, and care delivery—required for participating in CMS programs.

  • Understand how health IT is the foundation to better care, smarter, spending and healthier people
  • Learn about new health IT initiatives that can support practical needs of patients and providers


Elise Sweetney Anthony (@Policy2Progress) – Director, Office of Policy at ONC


3. Explore the Ingredients of a Health IT Value Strategy

Track and Time: MACRA Summit, Day 2 @11:30am

Implementing health IT does not guarantee success. These technologies—focused on improving care must allow stakeholders to be able to find usability and usefulness that also support processes—both business and clinical—of a value-based reimbursement system.

  • Review the HIMSS STEPS™ model and its five components
  • Identify areas where health IT has proven value and non-technical barriers to IT optimization
  • Explore potential new functions of health IT that should support value-based care


Peter Basch – Medical Director, Ambulatory EHR and Health IT Policy at MedStar Health

Patricia Wise – VP, Health Information Systems, HIMSS


4. Engage Physicians in ACO and Other Value-Based Models to improve Quality

Track and Time: ACO Summit, Day 2 @2:15pm

Successfully engaging physicians ensures that ACOs and other value-based endeavors reach potential, but that is easier said than done. It’s especially challenging when physicians continue to receive fee-for-service and value-based payments simultaneously.

  • Understand physicians’ risk-based payment and MACRA, and how to transition to a value-based mix
  • How to coordinate for optimal management of complex patients
  • Utilize integrated and actionable claims data, not multiple EHRs, and learn how to report data that demonstrates the impact of clinical decisions


Abigail Chen – Medical Director, Quality and Clinical Integration at Mount Sinai


5. Achieve Better Quality, Less Effort, and Greater Savings – How You Can Have All Three

Track and Time: ACO Summit, Day 2 @3:00pm

Through organizing information and communicating it with providers in addition to focusing on specific efforts such as cardiac and respiratory conditions, providers can improve cost and quality metrics in parallel and demonstrate the value throughout the health care community.

  • Explore feasibility of collecting and tracking patient data to understand quality performance
  • How cutting costs and increasing quality scores can earn shared savings
  • Illustrate examples of payer-provider engagement and alignment around shared objectives


John Haughton (@haughton_md) – CIO at Chautauqua AMP; CQO at Independent Health Plan


MACRA Basics: The Method Behind MIPS Scoring

cover mips scoring

When the sustainable growth rate (SGR) formula was set in stone in 1997, its sole intent was to better control the cost of healthcare payments to physicians. Payments towards clinicians were and still are predicated on volume of services, not value. If the overall physician costs were greater than Medicare expenditure targets, then physician payments were reduced.

Enter in MACRA, otherwise known as The Medicare and CHIP Reauthorization Act and we’re on our way to repeal the SGR formula and create an entirely new system that physicians must follow.


Old to the New

As the torch bearer in this shift towards value-based care, MACRA is proposing two payment systems that eligible physicians can choose to operate under; MIPS, or Merit-based Incentive Payment System and APM, also known as the Advanced Payment Model. The goal of MIPS is to provide physicians with the flexibility to choose activities and measure those most meaningful to their practice. With the introduction of Clinical Improvement Activities, a new performance category that physicians will be scored on, MIPS will consolidate the three categories that physicians already measured by; Quality, Resource Use, and Meaningful Use of Technology, forming the MIPS Composite Score as a result. The MIPS Composite Performance Score takes into account the weight across each performance category, performance factors, group performance, availability and applicability of measures, and special circumstances of nontraditional practices (practices located in rural areas and non-patient).


Are You Eligible?

First order of business: how do you know if you’re eligible to operate under the MIPS program? MIPS-eligible clinicians in the first and second year of the program include:

  • Physicians
  • PAs
  • NPs
  • Clinical nurse specialists
  • Certified registered nurse anesthetists

After the third year, the eligibility funnel expands, adding:

  • Physical or occupational therapists
  • Speech-language pathologists
  • Audiologists
  • Nurse midwives
  • Clinical social workers
  • Clinical psychologists
  • Dietitians
  • Nutritional professionals

You’re exempt from MIPS if you are:

  • In your first year of Medicare participation
  • Eligible for APM and qualify for bonus payment
  • Below the low volume threshold (Medicare billing charges less than equal to $10,000 and provides care for 100 or fewer Medicare patients in one year).
  • A hospital or facility

As you prepare your practice for MACRA, it’s critical to keep these four performance categories in mind, how they’re calculated, and how they tie-in together to form the MIPS composite score.


The Big Four

1. Quality

The quality performance category replaces the Physician Quality Reporting System, or PQRS, accounting for 50 percent of the MIPS composite score. Under the quality performance category, there will be six measures that doctors can choose to report on that best reflects their practice. In addition, doctors must also report on 1 high priority measure; outcome, appropriate use, patient safety, efficiency, care coordination or patient experience, and 1 cross-cutting measure.

Composite Score Weight: 50% in 2019

Maximum Possible Points: 80 to 90 points

Calculation and Scoring: Each measure equates to 1-10 points in comparison to historical reports. If a measure is not reported, score equals 0. Additional bonus points are awarded for patient experience, patient safety, care coordination, and EHR reporting.


2. Advancing Care Information

In the Advancing Care Information category, formerly known as Meaningful Use, clinicians are rewarded based on their performance of measures most favorable to them, reporting on key measures on interoperability and the exchange of information. The six objectives required to measure, as proposed by CMS include Protection of Patient Health Information, Patient Electronic Access, Coordination of Care Through Patient Engagement, Electronic Prescribing, Health Information Exchange, and Public Health and Clinical Data Registry Reporting.

Composite Score Weight: 25% in 2019

Maximum Possible Points: 100

Calculation and Scoring: A base score of 50 points is granted if the provider reports one or more use cases across each available measure. For each measure, up to 10 additional points are possible.


3. Clinical Practice Improvement Activities

Of over 90 activities to choose from, clinicians have the choice to measure activities best suitable for their practice. Those participating under medical homes earn full credit while APM participants earn half. Activity categories include Expanded Practice Access, Beneficiary Engagement, Achieving Health Equity, Population Management, Patient Safety and Practice Assessment, Emergency Preparedness and Response, Care Coordination, Participation in an APM, Integrated Behavioral, and Mental Health.

Composite Score Weight: 15% in 2019

Maximum Possible Points: 60

Calculation and Scoring: Each of the 90 activities is worth 10 points and “high-value activities” are given double the weight.


4. Resource Use

For clinicians and physicians, the score for the Resource Use or Cost category is based on claims and volume sufficiency. For this category, doctors need not report anything as CMS does the calculations. Clinicians that provide high-quality care for their patients achieve better performance, thus resulting in a higher score through being the most efficient in resource use.

Composite Score Weight: 10% in 2019

Maximum Possible Points: Average score of resources measures that can be attributed.

Calculation and Scoring: 1-10 points based on performance benchmarks.


What’s Ahead

As the final MACRA ruling is just a few months away, physicians—and hospitals—must prepare themselves by understanding the implications of MACRA—both MIPS and APM—and have actionable information on what they can do to address the proposed payment systems. While MACRA—if passed—goes into effect in 2019, both 2017 and 2018 performance and payments will be accounted for.  you can, not only improve your processes and workflows but more importantly, enhance how you serve your patients better in the continuum of care.

Are you looking to learn more about MACRA? Join us as we cover how to directly approach the new payment systems in our upcoming webinar, MACRA: Addressing the Transition, this Thursday, August 11th at 11AM PDT.



CMS Quality Payment Program NPRM

CMS The Medicare, The Merit-Based Incentive Payment System: MIPS Scoring Methodology Overview


Where EHRs Fall Short: 3 Reasons Doctors Need Personalized Population Management


Look into the center of a hospital’s information technology stack, and you’re bound to find electronic health record systems (EHRs) to be the cream of the crop, costing healthcare providers tens to hundreds of millions of dollars for implementation and use. As the core system of record within a healthcare organization, when it comes to providing the 360-degree view on any given patient or patient population, EHRs fall short on giving the complete picture.


The State of Electronic Health Record Systems

It’s no doubt that EHRs are critical to a hospital or health practice. An EHRs’ core capability rests on being able to store significant amounts of patient data records and is used across multiple functions—care quality, finance, and operations—within a health organization. Whether it’s capturing notes on patient encounters, insurance claim information, or data on historical visits, you name it—EHRs are effective in that regard. This, however, is what EHRs were designed to do, and nothing more; to operate as silos of unstructured data.

Storing data and interpreting data are two independent undertakings. It’s important for doctors to be able to distinguish between the two without overspending on time and resources. In order to capture the complete picture on a patient population, clinical and financial departments need a dedicated system that allows for seamless interpretation of patient data, predictability, and personalized patient communication at will. Keep an eye out for the following when looking into a population management solution:


 1. Predicting no-shows and patient risks

Tracking historical patient data is fundamental. But what about predicting and planning for the future? As healthcare providers continue to amass increasingly large amounts of patient data from socioeconomic to demographic inputs, not leveraging that data is an opportunity missed. Where EHRs lack, a Personalized Population Management™ can make up in value, as EHRs were not designed to predict future occurrences from their stored data. Doctors need a solution that not only enables them to manage no-show and cancellation rates but addresses dire questions like, Which patients within my population are at-risk? What are the leading factors for my patients’ risks? How can I improve the health of my patient population?


 2. The need to engage patients

Doctors and physicians want to spend more time doing what they do best: caring for their patients, not trying to make sense of high volumes of unstructured data. When relying on EHRs for patient engagement, physicians and nurse practitioners can face barriers; meeting personalized demands, usability issues, unnecessary workload. What doctors and physicians seek is a tool that not only gives back lost time from using EHRs but a tool that enables bi-directional patient communication even when patients leave the premise. This calls for a communication medium to be put in place dedicated to engaging patients and helping doctors get what patients need when they need it.


 3. Meeting regulatory reporting requirements

One thing is true. It’s becoming much more difficult for doctors to focus on their population. While the rise of the health IT landscape was meant to automate certain tasks, the reality is it’s taking up more and more of a doctor’s time. With new reporting and payment regulations underway, doctors must have a solution fixated to handling this department. EHRs alone aren’t enough and extracting data from these systems can be a daunting task. Orchestrated in alignment, however, EHRs and predictive analytics make a formidable pair. Together as the bread-and-butter of the health IT stack, EHRs and predictive analytics empower healthcare providers to capture data, interpret it for actionable insights—regardless of complexity or magnitude—and help providers with their patients in the continuum of care.


Personalized Population Management does not replace an EHR. Rather, Personalized Population Management complements a robust EHR system. In this new era of healthcare, predictability tied with communication and reporting gives doctors the ability to ultimately improve their financial and clinical outcomes and focus on what matters most, the patient.


The Medicare Access and CHIP Reauthorization Act (MACRA) is underway to completely change how healthcare providers approach medicare payments. Are you ready? Join us as we discuss how to approach MACRA in our upcoming webinar, MACRA: Addressing the Transition.