MIPS & APM: Common Concerns and Requirements

Posted by Cordata Health

March 13, 2017 at 1:53 PM


The Issue

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has introduced another step of the transition toward value-based reimbursements. When the final rule was released last October, many in the healthcare industry were unsure how to move forward in the new landscape.

This new care model includes two reimbursement paths for physicians: the Merit-based Incentive Payment System (MIPS), which consolidates three existing incentive programs rewarding performance and outcomes such as meaningful use, and Advanced Alternative Payment Models (APM) such as the Oncology Care Model (OCM). These new reimbursement measures are based on quality as opposed to the traditional fee-for-service model.


Now, it’s important to note that these incentives are for physicians, not facilities. So there’s plenty of wariness, especially among small practices and lone physicians. So, what can you do to ensure that the new care model helps the industry provide the best quality care for patients while also bringing down costs?

Common Fears and Concerns about Value-Based Payments

MACRA may seem insurmountable and complicated – you and your physicians may be concerned about complying, but you are likely already meeting many requirements through your EMR, such as protected health information, clinical summaries and other factors addressed as part of meaningful use guidelines. If you are also using the Cordata platform, you may be providing patients with personalized education, secure messaging and more – which are also required components for both MIPS and APMs.

These programs all hinge on engaging your patients – which equates to delivering smarter care. Therefore, focusing your efforts on MACRA will not only help you improve care, but also help you thrive in the new world of value-based care. And it’s also beneficial for changing patient behavior. Treatment outcomes are consistently better when patients have an understanding of how their own behaviors impact their health; engagement is the best way to instill that thought process and convert it into continued action.

How to Address Your Fears

A care coordination solution that offers engagement-focused features ensures that everyone is on the same page. When the patient is closely connected to their care team, consistent monitoring, proactive education and early intervention for patients become the standard and reduce the likelihood of an adverse event like a readmission, emergency department visit or disruption in a treatment plan. They will alert the care team when attention is needed and the patient is able to more deeply understand their diagnosis, treatment options and regimens as well as effectively administer self-care or engage with their team at appropriate times. 

Ultimately, engagement and coordination help improve care, reduce costs and enhance the patient experience. While engagement can seem like a lot of effort, its “triple aim” benefits are often an a-ha moment for organizations that achieve them. Engaging saves money for everyone, both patients and providers.

With automated engagement features on your care coordination platform, providers can do a lot more with fewer people and resources. A care coordination application aggregates information from the EHR and other relevant systems (because everything you need to know about your patients probably isn’t in your EHR) to be sure that each patient’s case can be centrally managed.

Adding engagement – custom interactions with patients over text, etc. – to the mix allows the care team to stay in contact with patients remotely and centralize patient information so that the right member of the care team can intervene when necessary. A variety of important tasks can also be automated, like delivering educational information and assessing patient distress, to ensure sustained quality treatment.

The healthcare landscape is shifting toward value-based care, and ensuring that patients are engaged and active in their own care is only going to get harder over time. Whether it’s MIPS, OCM or another program, the future is here – delivering smarter quality care at a lower cost. The 2017 reporting period for MACRA has kicked off – is your organization ready to go beyond simple “tick-the-box” data collection and actually take advantage of the opportunity to improve care and the patient experience.


Topics: Value-Based Care, MACRA

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