1. MACRA Measures & Insights

2. MACRA highlights
New rule on Medicare physician reimbursement reforming the payment model via a quality-based payment program through bonus and penalties tied to performance.
Broader push to overhaul federal health spending.
2017 is a transition year with changes expected every year.
“Of 1,367 quality measures, more than 800 overlapped or had similar focus, according to the agency.” -NQF*
*Source:
Source: U.S. Officials Finalize Rule for Medicare Payment to Doctors
Melanie Evans, Oct 14, 2016

3. MACRA creates two new payment tracks replacing the physician fee schedule:
APM QP
0.5%
0.5%
0.5% 0% 0% 0% 0% 0% 0% %
PFS %
2017
2018
2019
2020
2021
2022
2023
2024
2025
NON QP
Payment year
Performance year
Value Based participation bonus 5%
Alternative Payment Models (APMs)
2017
2018
2019
2020
2021
2022
2023
2024
2025
Payment year
Performance year
Up to +/- or neutral + Bonus up to 3x
Merit-Based Incentive Payment System (MIPS)
+/- 4%
+/- 5%
+/- 7%
+/- 9%
+/- 9%
2017
2018
2019
2020
2021
2022
2023
2024
2025

4. Regulatory and Payer Pressures
At our last webinar we polled over 700 attendees about MACRA* and the number one concern from the audience was compiling metrics for regulatory reporting.
A survey conducted in March, 2016 by Weill Cornell Medical College and the Medical Group Management Association (MGMA) found that physicians spend an average of hours every week processing quality metrics.
15.1
*Medicare Access and CHIP Reauthorization Act of 2015

5. Current State for Managing Measures

6. Align and Integrate the data
Financial, regulatory AND quality departments need to come together.
“We do quality initiatives focused on diabetes patients but I don’t know what other groups are doing.”
“We have contracts with BCBS and Aetna that have quality measures in them as well, but we don’t know what they are.”

7. What is MACRA Measures & Insights?
Foundation for integrating hundreds of measures across financial, regulatory & quality areas
212 of the 217 MACRA quality measures are pre-loaded out of the box.
Platform supports most major EMRs, claims and other data sources.
Enables proactive surveillance of measures to enhance outcomes
Performance scores in three initial MIPS quadrants
Helps organizations tactically & strategically identify measures for risk based contracts
Add measures from commercial payer contracts
Identify populations & measures for optimizing at-risk payments

8. Do You Have the Data to Support the Measure?

9. Monitor Your Performance to the Measures

10. MACRA Measures & Insights
Foundation for integrating hundreds of measures across financial, regulatory & quality areas
212 of the 217 MACRA quality measures are pre-loaded out of the box.
Platform supports most major EMRs, claims and other data sources.
Enables proactive surveillance of measures to enhance outcomes
Performance scores in three initial MIPS quadrants
Helps organizations tactically & strategically identify measures for risk based contracts
Add measures from commercial payer contracts
Identify populations & measures for optimizing at-risk payments