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Under The Value-based Umbrella
  • Tina Colangelo
  • Dec 15 2017

MACRA is an evoluntionary process that will take place over many years. There are many moving parts under the value-based umbrella that are vital to the business models of  healthcare organizations across the country. To excel, they must understand and implement all of the moving parts to stay ahead of the competition. Under the value-based umbrella, you will find MACRA requirements, patient engagement, clinician/organization public reputation, and chronic care management. It's not enough to just learn the first component of value-based care-MACRA's requirements to stay ahead of the game. Since the environment is soley based on winners and losers, public reputation becomes equally important. Patient engagement must also be a focus, as the overall goal of all value-based programs is to make our healthcare system patient-centric. All of the parts must move together-not just one. If your organziation is not focusing on the other components, your business model will be out of balance and so will your bottom lines. Chronic care management ties the moving parts together and helps finance restructuring investments that meet the needs of  value-based care business models. 

There are many resources available that can be used to help understand what seems like endless requirements of MACRA. To list them all would be time consuming. Healthcare organizations can start at the qpp.cms.gov website. It's free and easy to navigate. Healthcare organizations need to find creative ways to engage their patients. Don't be afraid to borrow marketing ideas from companies such as Southwest Airlines. The reality is that healthcare was always a business. Patients just didn't pay as much. Now that they are paying almost forty percent more in health insurance premiums, it is.  Healthcare was also never patient centered until the emergence of value-based care programs. Value-based care forces providers to rely on their patients participation in their own healthcare, just to get reimbursed by Medicare.  Essentially, the patient-provider relationship strengthens as they work as a team. Financial incentives are becoming popular among health plans and medical practices in an effort engage patients to make healthier choices. Financial incentives are not the only way to engage patients. A simple acknowledgement of a patient's birthday will do. Praise is also free and goes a long way. 

Just like consumer reviews and social media are vital to the success of any business, healthcare is no exception.  Medical practices, health plans, and hospitals will now need to market their practices to the public on social media. Patients are living longer and look on the internet to find new doctors, specialists and hospitals. More importantly, the Centers for Medicare and Medicaid (CMS) will now display all eligible clinician's MIPS composite performance scores on physiciancompare.gov. Patients  will be able to comparison shop, before choosing a provider.  With an estimated 10,000 patients joining Medicare a day, healthcare organizations are going to want new business. Large groups such as hospitals will negoiate big salaries and pay bonues to employed clinicians with the highest scores because after all, their reputation is on the line. 

So, as the first performance year comes to a close, we see that only focusing on MACRA's requirements can be detrimental as it's only one moving part. Going forward, all moving parts are needed in order to prosper in the value-based care landscape. 

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