The tech side of MACRA
By: Randy Thomas, FHIMSS | June 27, 2017
Exploring the IT infrastructure healthcare organizations will need to support their move to Advanced APMs.
Implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has already begun, and organization need to step up their planning to be sure they are prepared. A key component of a successful MACRA implementation is the technology behind the transformation. Planning for IT-enablement is vital to positioning any healthcare organization for success in this value-based payment world.
Healthcare organizations today operate in an environment with multiple disparate data sources, including heterogeneous electronic health records (EHRs). To effectively manage population health through Advanced Alternative Payment Models (APMs) -- which are a core component of the MACRA process -- requires technology that can bring this data together to rapidly inform decision-making, measure performance and outcomes, enable data liquidity, and operate in a heterogeneous environment of data sources.
To create that environment, organizations need to establish an IT infrastructure roadmap focused around three fundamental capabilities – care management, patient engagement, and analytics and measurement. To ensure data flows as unencumbered as possible, health information exchange (HIE) capabilities must also be leveraged. As a health system defines its roadmap, it should consider EHR-agnostic approaches to ensure all stakeholders engaged in coordinating care, including patients and providers, can “sing from the same hymnal” and have appropriate access to complete longitudinal patient information.
In today’s environment if a patient has more than one physician and has visited a hospital they are likely to have multiple patient portals – regardless of whether their providers are all in the same network. Patient portals are tethered to the underlying EHR. This is not a sustainable solution. To effectively build IT-enabled patient engagement patients will need a single portal that pulls together all of their longitudinal information. At this point the technical challenges are significant, but this is particularly important to Advanced APMs with the emphasis on patient engagement. Some vendors are now describing this capability on their development roadmaps; healthcare organizations should be aware of this in ongoing discussions with their vendor partners.
The IT plan should include definitions of the various care management use cases that can then be tested against existing capabilities or used as part of an application selection process. In addition, a data integration plan must be defined, implemented, and continuously monitored since changes in the source systems can affect the data flowing to the care management application. These are typically time-consuming critical path items, and healthcare organizations should be sure they set aside ample time and talent to address these issues.
To ensure the information needs of the organization are being met with respect to value-based care, an inventory of all existing technology should be conducted. The capabilities represented by this inventory should then be compared to the goals and objectives of the organization, and redundancies and gaps should be identified. That information can be used to establish remediation plans for the gaps and redundancies – or to justify their existence. In addition, data from various applications should be evaluated for accuracy and completeness. Often organizations discover that data which is “supposed” to be the same is sourced from different places and is conflicting. To support the above technology considerations, process and people skills are required to take advantage of the acquired technology, implement the new processes, and interpret the information created.
Stay tuned for our next post where we will dive into the related processes and people skills that enable the right data are provided to the various stakeholders at the right time to support the required functions.