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Top 5 Strategies to Succeed Under MACRA: Page 2 of 2

Top 5 Strategies to Succeed Under MACRA: Page 2 of 2

The single most overlooked opportunity to control both cost and quality of care is the referral, because it is both the trigger point that money is about to be spent and an early indicator of a decline in health. Only by placing patients with the highest value provider and maintaining visibility into that patients care across the continuum can providers effectively manage both cost and quality. 

According to "Adopting Accountable Care: An Implementation Guide for Physician Practices," Engelberg Center for Health Care Reform at Brookings, developing a high value referral network is critical to success.  By coordinating referred care for their patients across the community, clinicians are able to maintain control of the downstream quality and cost of care, thereby maximizing their MIPS score and APM revenue.

3. Participate in Medicare's Chronic Care Management Program (CCM)

Engelberg also cites managing high risk patients as a key to success in accountable care.  According to CMS data, 93 percent of Medicare fee-for-service spend is on people with multiple chronic illnesses.  The importance of proactive and frequent care management of these poly-chronic patients cannot be overstated under MACRA.  An effective way to address these high risk patients is via the CMS CCM program (CPT 99490).  Through CCM, CMS is both subsidizing the necessary infrastructure and resource investments to be successful under MACRA and helping to fund preventive care management of the most costly segment of the population.  Take advantage of it. 

4. Prioritize technology investments based on ROI

Technology and process investments should be prioritized to support the most essential elements that deliver rapid ROI, as opposed to an "all or nothing" approach.  Your priorities will depend on your specific organization, but fully reporting your performance and getting control of your attributed costs need to be addressed.  To avoid unnecessary financial risk, beware of investing heavily in areas like population health management solutions and predictive analytics before you have enough lives under value-based contracts to realize ROI.  You may be able to start by leveraging clinicians to identify high risk patients, and leverage EHR data to identify the larger population of poly-chronic Medicare patients for engagement. 

5. Lead with value

Payer contracting is shifting rapidly in competitive markets from negotiations based on pricing power and network participation, to value-based contracts that reward outcomes.  In addition to succeeding under MACRA, groups that implement the strategies outlined above will have a competitive advantage with private payers.  By positioning yourselves as the leading value player in your market, you can win commercial contracts and gain further economies of scale.

While the final rule won't be known until late in the year, we know enough now to take action in the right direction.  Those that start sooner will have a first mover advantage that is hard to catch up to.  Those that delay may very well dig themselves a hole they can’t climb out of.  Regardless of how the final rule shakes out,  the strategies outlined above will prepare clinicians to be successful in the new world of risk-based payments.


Mark Hefner is CEO of Infina Connect Healthcare Systems, the leading provider of SaaS referral coordination solutions. Previously he led healthcare IT businesses for Allscripts, GE Healthcare and Hill-Rom. Mark holds a BS in Electrical Engineering and a MS in Management from Georgia Tech.


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