So You Want to Know More About MACRA? Introducing the National MACRA Advisory Council
By Mark Stevens, Managing Director, National MACRA Advisory Council
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Final Rule was issued on November 4, 2016, ushering in with it much needed reform, but not without the added confusion and consternation now all too common for those transitioning from volume to value-based care. SpectraMedix, a leader in enabling healthcare organizations to improve care delivery and transition to value-based payment models, decided to do something to alleviate the confusion by forming the National MACRA Advisory Council (MAC). In this article we will review key goals of the MAC and discuss with its members their perspectives on MACRA.
The MAC is an independent, voluntary group, administered by SpectraMedix, made up of healthcare delivery, policy and IT experts who will work to advance the goals of the MACRA program and provide solutions to challenges that executives, administrators and clinicians face as they implement its Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) tracks. Additionally, the Council will focus on state Delivery System Reform Incentive Payment (DSRIP) Medicaid reform initiatives, the Medi-Cal PRIME program and other 1115 waiver-related programs.
The Mission of the MAC is two-fold:
1) Provide policy and operations guidance to payors, providers, ACOs, and other HCOs regarding Best Practices for MACRA, MIPS, DSRIP, PRIME and other 1115 waiver-related programs; and
2) Leverage process re-design and optimal IT resource deployment to help the health and public health sectors achieve their population health, financial, and regulatory goals.
The vision of the group is to assist the healthcare industry achieve the “Triple Aim” through clinical, operational, and administrative excellence in the management of MACRA, MIPS, DSRIP, PRIME and all 1115 waiver-related initiatives and programs.
Q&A with MAC Leadership
Question/Stevens: Sajid, what is priority for the MAC?
Sajid Ahmed, MAC Co-Chair: This is a unique opportunity to really dig deep into how MACRA will work, and understand how it will impact healthcare organizations, practices and physicians over the short and long term. It will allow us to share our experiences, learn from others and collaborate on innovative paths forward.
Stevens: Sri, what should the average physician practice – or IDN – expect to budget to adequately meet the requirements under MACRA (including technology, and how much for consulting support, process re-design and/or staffing)?
Sri Bharadwaj, Co-Chair, MAC Technology Workgroup: From a technology perspective, the “asks” depend on the measures that need to be managed and reported. A recent study outlined that US Physicians spend nearly $15.4 B to report quality measures (HEALTH AFFAIRS 35, NO. 3 – 2016). So the cost is going to be rather high for EMR vendors to make updates to EMR software, capture information, generate and validate metrics and then submit to the agencies for meeting MACRA requirements. On an average the cost would be about $5K per physician based on the study.
Stevens: David, with the ACA “repeal & replace” bill pulled from a vote in the House, what other potential policy movement do you foresee regarding MACRA?
David Muntz, Co-Chair, MAC Policy Workgroup: The overall goals [of MACRA] appear to be good. The execution, however, presents many challenges including the cost of transitioning to the new models. Many organizations and individuals are lobbying to get more time to allow providers to adjust the people, processes, and technologies enabling participants to meet the administrative changes and report on the clinical measures. Educating providers, particularly the physicians, about the choices and allowing time to figure out how to participate requires evidence and time.
Stevens: Karena, what questions do you believe providers should be asking to better understand MACRA?
Karena Weikel, Co-Chair, MAC Finance Workgroup: Healthcare organizations should begin to ask who is responsible for MACRA. Our chief medical officer at Geisinger Health Plan has the responsibility to oversee our participation in MACRA. To get a better understanding of our approach, I asked him fourteen (14) questions. I learned from his response that the broad theme for MACRA is that physicians will be required to take on more risk. So, as the Vice President of Risk and Revenue Management for Geisinger’s Health Plan, I’m grateful for participating on the MACRA Advisory Council, and looking forward to gaining more insight into Best Practices for MACRA from around the country, and learning how to mitigate risk under MACRA.
Stevens: Christina, what role does MACRA play in helping to keep patient and consumer engagement at the heart of payment reform?
Christina Caraballo, Co-Chair, MAC Patient & Family Engagement Workgroup:
As the market shifts toward value based models of care, the concept of supporting more holistic approaches to healthcare with patients playing an essential role in the care continuum is vital. MACRA weaves in patient engagement throughout the regulations. However, in an effort to give organizations the flexibility to implement solutions tailored to the unique needs of their population and meaningfully integrate those solutions into workflows, it is not overly prescriptive in mandating how care providers incorporate patient engagement tools. The onus is on the health IT community to help care providers better understand short and long term approaches to incorporate technologies that will enhance the patient and provider experience while becoming an inherent part of care. This is one of the primary areas we are excited to tackle within the MACRA Advisory Council by facilitating open dialogue with multiple stakeholders.
Stevens: Raj, what did you see as the value proposition for your company, SpectraMedix, to sponsor the MAC?
Raj Lakhanpal, M.D., President/CEO, SpectraMedix: SpectraMedix is honored to sponsor the National MACRA Advisory Council. The Advisory Council represents our commitment to the advancement of both our clients and the industry as a whole as together we transition from volume to value-based care. We searched extensively to identify Council members who could answer some of the big questions to help support provider organizations and physicians as they transition from volume to value. We are excited to have brought this talented group of individuals together who collectively bring both deep and broad healthcare industry experience with a diverse set of skills and specialties. We will work with them to bring Best Practices and insights to the healthcare industry as a whole.
The MAC has fourteen founding members, and includes four (4) workgroups, each with its own co-chairs: 1) Policy; 2) Technology; 3) Finance and 4) Patient & Family Engagement.
- Sajid Ahmed, CIO, MLK Health, South Los Angeles; Co-Chair
- Ken Bradberry, CTO, Conduent, Co-Chair
- Charles Aunger, Managing Director, Health 2047
- Karen Bell, Director, JBS International; former Office of the National Coordinator for Health IT (ONC) Director; Author, ACO HIT Framework
- Sri Bharadwaj, Director of IT and CISO, UC Irvine Health; Past President, SoCal HIMSS
- Christina Caraballo, Strategist, Get Real Health; Awardee, HIMSS Most Influential Women 2016
- Dee Cantrell, President, HIT Consultancy, LLC; President, Georgia HIMSS; former CIO, Emory Health
- Drex DeFord, President, Drexio Digital Health; former CIO, Scripps; former CHIME Board Chair
- Neil Gomes, SVP and Chief Digital Officer, Jefferson University and Health System
- Mike Ilnicki, President, DataGen (Hospital Association of NYS)
- David Muntz, Principal, StarBridge Advisors; former Principal Deputy National Coordinator, ONC
- Karena Weikel, VP, Risk & Revenue Management, Geisinger Health Plan
- Erik Muther, Managing Director, Health Care Improvement Foundation
- Tamara StClaire, PhD, Former Chief Innovation Officer, Xerox Healthcare
- Raj Lakhanpal, CEO, SpectraMedix (Ex Officio).
Mark W. Stevens
To learn more about the National MACRA Advisory Council visit http://www.spectramedix.com/mac/