Best Practices for Providers Looking to Improve the Quality of Care

In all areas of healthcare, organizations are looking for innovative ways to reduce costs and improve quality. According to a new study published in Health Affairs, MACRA could reduce CMS physician services spending from $35 billion to $106 billion. MACRA is also leading the way towards quality healthcare by creating incentives and penalties for providers who leverage the program to improve quality and efficiency of care. For providers to succeed under MACRA, they must work collaboratively with payers to meet the quality objectives defined by CMS.

In order to qualify for incentives and avoid penalties under MACRA, providers have the option to choose from two payment models: MIPS and APMs. Under MIPs, providers’ performance on quality, EHR use and practice improvements will be measured this year to determine the incentives or penalties they will receive in 2019. CMS is expected to notify physicians who are eligible for the program by the end of the month. APMs give incentive payments to providers that offer high-quality and cost-efficient care and can apply to a specific clinical condition, a care episode or population.

This week, our blog shares three steps providers can take to help ensure they are successfully meeting the requirements under these programs:

• Ensure Access to the Correct Tools – In a recent blog post, John Hansel, vice president of provider solutions, notes, “CMS’ quality reporting is complicated. There are numerous requirements that providers need to meet – from patient satisfaction to Electronic Health Record reporting –  which can be difficult to manage. To ensure healthcare organizations are on track with these measurements, they need to have the right tools and insights in place to meet CMS’ various measures.” As providers look to improve quality and find success with the ever-evolving quality measures, they must ensure they have the correct tools in place to find success in improving patient care.
• Work with Payers to Break Down Data Silos – Although there has been some improvement in breaking down data silos, data preparation still accounts for nearly 80% of the work included in acquiring and preparing data. This can prevent the health system from getting a holistic look at the total patient record. To steer away from these data silos, providers need to leverage their relationship with payers, who typically are the only entity that have the data required to create a holistic patient record. Payers can provide access to crucial information, including the care received when the patient goes out of network. Overall, the shift to VBC requires that payers and providers work together in this aspect.
• Adopt Technologies Aimed at Improving Quality Measures – To truly succeed in improving the quality of care for the patient, providers must adopt technologies that serve as a basis for their collaboration efforts with payers. These programs must be able to successfully measure and monitor quality measures and create data driven conversations so payers and providers are aware of how to best improve quality for their populations. MedeAnalytics’ quality management solution offer insights that enable health plans to fully understand performance on quality measures and ultimately improve quality care for members.

At the end of the day, providers should be aiming for one goal: to improve patient care. To successfully provide patients with the best care possible, providers must work with the right tools, successfully leverage payer data and adopt technologies that serve as a place for collaboration with payer partners.

For more on how your organization can best improve the quality of care for your members, access our whitepaper, Enabling Payer and Provider Collaboration in the Journey Toward Quality Care. To find out how MedeAnalytics can act as a strategic partner in this journey, learn about our quality management solution here.