Tackle These 8 Challenges of MACRA Quality Measures

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The Medicare Access and CHIP Reauthorization Act (MACRA) era is upon us. Passed with overwhelming bipartisan support, and addressing cost reduction and quality improvement, MACRA is here to stay, regardless of the continued uncertainty surrounding the future of the Affordable Care Act.

This seeming permanence means that Merit-Based Incentive Payment System (MIPS)-eligible provider organizations that have been practicing watchful waiting from the sidelines must now determine how to proceed. 2017 is a transition year; doing something is overwhelmingly the right approach. While non-participation will result in a negative four percent payment adjustment, submitting something—one quality measure, one improvement activity, or four to five required advancing care information measures—will prevent a downward adjustment. Partial or full submission may result in a positive adjustment, and for reporting year 2017, an organization can submit as few as 90 days of quality reporting data, meaning that capturing performance can begin as late as October 2, 2017.

Uncertainty about program implementation dates, permanence, and impact size, coupled with the myriad competing priorities all health systems face, has led some organizations down a less resistant path. The 2017 strategy may be to simply duplicate prior Physician Quality Reporting System measure strategies and apply this single set across all physicians in the system. However, the rapidly increasing financial impact of prospective bonuses vs. penalties, and more stringent participation requirements in each subsequent year of MACRA, are now spurring many of these organizations to craft a more nuanced, thoughtful reporting strategy for 2018 and beyond.

Plan a MACRA Strategy to Meet These Eight Challenges

A key question for many practices is how best to identify MACRA quality measures to report on for an optimal score in the quality performance category.

MACRA Measures & Insights™ provides fluency in the new regulatory environment, where confusion, misunderstanding, and missed opportunity can easily develop. Powered by the Health Catalyst Analytics Platform™, this product enables deep insight into performance measures at virtually any degree of detail required for measurement and performance improvement.

This is a multidimensional tool for administrators to provision and integrate data from hundreds of measures across every department. It can facilitate solutions to the challenges described below and significantly decrease the resources required to function in this new regulatory environment.

Challenge #1: High-level performance insight

Understanding the overall performance of a health system across a variety of locations, providers, and EMRs, to identify key areas of focus can be surprisingly difficult and time consuming. Leveraging claims data can provide a holistic view of the patient population and its full continuum of care. Measures with strong historical performance can be identified as well as specific trends on a system, department, location, or provider level. While not perfect, this can provide important input for determining which measures to go at risk on, or focusing improvements for the current performance year. Organizations can maximize ROI by targeting areas where success is most plausible.

Solution: MACRA Measures & Insights allows the user a view into all the MACRA quality measure at the level of groups, practices, and providers, to visualize relative performance internally and across MACRA domains.

Challenge #2: Defining measure specifications

Each provider participating in MIPS must submit sufficient data for six quality measures to achieve the full performance score. Success on any given measure comprises both high quality care provision and high data quality. Put another way, it is not enough to have every eligible patient receive all the care she needs; this care must be documented with the appropriate codes or language to be counted as complete. It is important to understand what CMS defines as acceptance criteria to get a patient into both the denominator and numerator of the measures that will drive a performance score.

Solution: MACRA Measures & Insights has built-in CMS measure specification logic to help organizations achieve full quality performance scores.

Challenge #3: Data quality reporting requirements

Many MACRA measures require data elements or codes infrequently captured in discreet fields or imprecisely recorded. A practice may be providing 100 percent of needed depression screenings, but if this isn’t visible in the data, then performance at the end of the year will look inadequate, or possibly be submitted only with a large amount of manual chart extraction.

Given this process, there’s an ocean of data points to consider. With the chosen reporting mechanism, will performance be better on foot exams or hemoglobin A1c scores with diabetes patients? Childhood immunizations or adolescent immunizations? Breast cancer screening or cervical cancer screening? By integrating all these data points, a provider can determine the high-performing measures, report on those, and steer clear of measures that may have data quality issues until those issues are resolved.

Solution: The Data Quality feature in MACRA Measures & Insights illuminates those measures with criteria met, source system issues, insufficient measure data, and details the numerator and denominator.

Challenge #4: Benchmarking data

While higher scores on any measure will always be better, rates across measures do not provide the most meaningful insights into where strengths or weaknesses may lay. Having 90 percent of patients with HbA1c under control is notably more impressive than having 91 percent of patients with a BMI documented. Success in quality measures is partially based on moving targets—benchmarks established by the results of provider peers, which CMS calculates and provides only after the performance year is complete. Organizations need a tool that does more than help choose measures on which they are successful as compared to benchmark. It is even better if they understand where the benchmark may shift, to know the standard to which this year’s performance will be held. 

Solution: MACRA Measures & Insights displays performance on each measure relative to national benchmarks, as well as user-specified benchmarks or targets. 

Challenge #5: Proactively increasing measures surveillance to enhance outcomes

Too often, provider organizations don’t know where they stand on any measure until the performance period is over. Not only does this not allow for any sort of course correction that could change the financial impact of the performance, but by the time a provider sees where the care gaps existed, it is often too late for them to impact patient care.

Integrating data (EMR, ambulatory, lab, claims, etc.) into a single repository, such as a data warehouse, and providing dashboards or portals for providers to be proactive, understand where to intervene, and setup improvements for individual success, will enable the entire organization to proactively improve patient care and achieve a higher quality score. 

Solution: The Performance Details feature of MACRA Measures & Insights can filter measures by data source, payor, provider, provider group, MACRA domain, cross-cutting area, and other categories to visualize your data in a proactive and responsive manner. 

Challenge #6: Strategically aligning measures on which to base risk

MACRA was passed as part of the growing national urgency to bend the cost curve of providing healthcare, while ensuring quality is maintained or improved. The quality measures that are part of the program were not created in a vacuum. For nearly all providers, other contracts exist with their own associated quality measures. When thinking through MACRA strategy, ensure insight into other applicable commercial value-based payment contracts, CMS initiatives (e.g., Medicaid), and local and regional market pressures. Oftentimes, there may be significant areas of overlap where focusing on improvement may help maximize the ROI of any investment in quality measure performance.

Solution: The Measure Alignment feature in MACRA Measures & Insights allows the user to add more than just MACRA measures, including additional contracts and financial arrangements. This cross-cutting view of organizational priorities helps identify areas of overlap they may want to target.

Challenge #7: Identifying measures with the largest financial impact

Although the measures chosen to submit under MIPS are each worth the same number of maximum points, alignment is more powerful when the relative financial impact of each targeted area is understood. For example, perhaps both diabetic foot exams and breast cancer screenings are present in a commercial payer contract. Intervening in either of these areas might make more sense than for a measure that exists in MACRA alone. However, if the commercial contract containing foot exams is worth a fraction of the potential quality dollars as compared to those available from the payor measuring breast cancer screenings, then it may be more prudent to target the latter. 

Silos often exist between commercial and government contracting groups, or between quality and financial groups within a healthcare system. User-supplied financial details must be aggregated for unencumbered analysis to understand the full financial impact of quality measures.

Solution: MACRA Measures & Insights gives users a more holistic view by allowing them to combine and analyze their information in new ways through aggregating financial, quality, and contracting data.

Challenge #8: Taking risk in multi-year, value-based contracts

Many health systems have the ability to negotiate with commercial payers on the specific measures they include in value-based contracts. If organizations are aware of their existing strengths and weaknesses in their data and processes, as well as areas they must focus on to be successful in existing contracts, then this can be used to inform these contract negotiations and to ensure selection of measures with a likelihood for success.

Solution: MACRA Measures & Insights can ingest historical measure performance data for comparing to established benchmarks giving administrators the information they need on which measures to include or exclude from at-risk contracts and/or government reimbursement programs.

There’s Help for Organizations Developing Their MACRA Strategy

In addition to addressing the challenges listed above, MACRA Measures & Insights can drill down into provider practice performance variation and integrate with other applications, such as Community Care. If a group decides to go at risk on a subset of measures, these can flow into the Community Care app, which tracks at provider and patient levels. Community Care can also display care gaps in the EMR, notifying physicians of needed interventions at the point of care.

MACRA Measures & Insights can analyze the lack of compliance on, for example, depression screenings, to help decide if there’s a data capture issue or provisioning issue. The product can stratify performance, enabling an analyst to see problematic trends or areas of excellence, allowing that to be applied to the rest of the system.

For many provider organizations, MACRA’s financial implications are large enough to make a difference in their financial sustainability, profitability, or margin. They could also require sizeable investments in infrastructure, like quality improvement, to succeed. If an organization can make a single investment, but reap benefits across all its payers, then it can be more cost effective and liberate more resources for improving patient care.

Easing the Submissions Process

There are multiple reporting mechanisms available depending on the MACRA reporting model (e.g., the EMR, qualified clinical data registry reporting mechanisms, or the Group Practice Reporting Option). While MACRA Measures & Insights is not a certified submission product, Health Catalyst® is exploring avenues, with CMS and other vendors, to streamline data extraction and make the submission process easier for healthcare systems.

MACRA Measures & Insights Relieves Reporting Headaches

The prospect of reporting under MACRA invites many complex and time-consuming decision processes, as provider practices consider the vast matrix of measures and complex reporting requirements. MACRA Measures & Insights is a Swiss Army Knife for measure managers. The tool is a flexible framework that tracks CMS and other payer measures to give valuable performance insights for provider organizations. Multispecialty clinics can benefit by aligning across common measures for their specialties or tracking by individual provider within this tool, thus easing the burden.

MACRA Measures & Insights integrates data from multiple data sources—EMRs, claims, and patient experience surveys, to name a few—to break down silos between departments so they can aggregate financial details and paint a complete picture of the MACRA landscape.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

  1. Introducing Health Catalyst MACRA Measures & Insights—Addresses Top Physician Concern: Capturing Compliance Measures
  2. Are Health Systems Ready for MACRA? Survey Reveals the Number One MACRA Concern and Varying Degrees of Readiness
  3. Preparing for MACRA: A Comprehensive FAQ for Physicians
  4. How Physicians Can Prepare for the Financial Impact of MACRA
  5. Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program
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