Many organizations are scrambling to figure out how to meet requirements for CMS' new quality payment program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). But while MACRA may be confusing, the underlying principles are simple: provide good care, do it at as low a cost as possible, use HIT as an underpinning for that care and continue to improve your practice.
The reality is, the concepts in MACRA aren't unique to clinicians who treat Medicare patients: Most public and private insurers are moving from a fee-for-service model, where they pay for volume, to value-based payment models, which consider the quality of care and costs. MACRA supports this nationwide change by working toward aligning how all insurers reward value.
So how best should you meet evolving payer needs? The patient-centered medical home (PCMH) model builds better relationships between people and their clinical care teams, as well as between clinicians. This model has been shown to improve quality, reduce costs and improve patient satisfaction – all goals of MACRA.
There are six concept areas that make up patient-centered care:
Team-based care: To be an effective patient-centered medical home, a practice must assign clearly defined roles and responsibilities to team members and ensure structured communication. This helps ensure the processes and activities established are effectively executed.
Know and manage your patients: A practice should have processes for gathering patient information, and for using that information to deliver quality care. For example, keeping up-to-date problem lists for all patients, with current and active diagnoses; completing comprehensive health assessments; conducting behavioral health screenings; assessing the diversity and language needs of its population. A practice that knows its patient population—and understands the population's needs—is equipped to provide appropriate care to its patients.
Patient-centered access: The PCMH model promotes continuity of care through patient-centered access. This means that clinicians and patients can access care, retrieve important information and get clinical advice, when and where they need it. It means that a practice has a secure electronic system that lets patients communicate with clinicians and request prescription refills. It means that the practice considers the needs and preferences of its patients when establishing processes and systems for access.
Effective care management: Some patients have complex health needs and require a greater level of support. One way to help manage higher-risk patients is through care management programs, which can create healthier patients and help reduce costs for the patient and the health care system. Appropriate care management and support ensures that a practice identifies service needs at the patient level and the population level, and manages/coordinates care in partnership with patients, their families and their caregivers.
Care coordination and care transitions: A significant cause of preventable readmissions is caused by poor communication and coordination of care during transitions. To improve the health of people with complex medical conditions and avoid dangerous and costly complications and hospitalizations, care should be coordinated effectively, especially during transitions of care between settings.
Quality Improvement: At the heart of patient-centered care is continuous quality improvement. A practice should live and breathe data-driven improvement in clinical quality, efficiency and patient experience—measuring its performance against goals or benchmarks and prioritizing and implementing changes that improve care. A few tips for successful Quality Improvement:
- Choose relevant measures. When measuring for quality improvement, make sure the measures are important to a significant segment of your population. For example, a practice with a large population of patients with diabetes might focus on measures specific to diabetes.
- Make sure staff understand the value. Explain to the team that tracking and measuring performance will help improve the practice's processes, and patient care in turn. It will help get staff buy in if you can connect what you do to how it helps the patients. Otherwise these tasks may just be seen as added work.
- Get team buy-in. Discuss the goal with the team and ask for their feedback about how to meet it. Team members can give accurate input about how much time a task will take and how to accomplish it efficiently, effectively, and accurately. An enthusiastic and invested team will strive to reach a goal and reminds them of their purpose as health care professionals.
While the PCMH model can help you succeed in MACRA and is a key building block to improving the quality of care, ultimately isn't this also the type of care we all want as patients?
To learn more about NCQA's MACRA Toolkit, click here.