Rebuilding the foundation of health care under MACRA

The Deloitte Center for Health Solutions and the Network for Excellence in Health Innovation (NEHI) convened 31 senior leaders from across the health care industry—health care providers, health plans, biopharmaceutical companies, and medical technology organizations—to discuss the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Health care organizations have built systems based on a fee-for-service (FFS) foundation. But those systems won't function under MACRA. Changing something as pervasive as FSS is going to take time and will pose challenges to many health care stakeholders. But, findings from our cross-industry discussions suggest that many health care organizations are ready to come together and begin building a new foundation based on clinical delivery and payment models not constrained by FFS rules.

Most US health care organizations have built their foundation—poured concrete—on the financial incentives in fee-for-service (FFS) payment models. Changing their systems and processes to respond to MACRA's very different incentives will take time and is likely to pose challenges for many health care stakeholders. But findings from our cross-industry convening suggest that many health care organizations are ready to come together and begin rebuilding their foundation based on new clinical delivery and payment models. Convening executives agreed that, under MACRA:

• Technology and data are paramount. Stakeholders will need technology and data solutions to produce and synthesize insights across the delivery system, as MACRA will require organizations to use data to report on physicians' performance, gain insight into what can be done differently, and determine how to improve performance. Collaboration models that share disparate data sources in ways that integrate and harmonize different data sets and make data actionable could enhance these insights. However, many executives questioned how data sharing will happen and who should have and control access.
• Change will be hard, especially taking on risk. Many health system leaders said they want to take on more risk, but doing so is a challenge for their organizations as well as for individual clinicians. Many clinicians worry that they lack the tools and capabilities needed to change clinical models.
• Everyone should be at the table. MACRA's fast-paced rollout and broad reach will require organizations across the health care system to work together; however, many executives said they are hindered by organizational, competitive, and regulatory barriers.
• Patients should be front and center. Patient outcomes and experience need to be a core focus for all health care organizations; this will likely require new patient and clinician engagement models.

Explore additional takeaways from the convening and smart next steps for health care providers, health plans, life sciences companies, and government as industry leaders collaborate to lay the foundation for MACRA. Read more in: Rebuilding the foundation of health care under MACRA.