Here comes MACRA: Analytics can help you measure and manage

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Medicare payment changes are coming. The Centers for Medicare and Medicaid Services (CMS) has announced the intention of increasing the proportion of payments to providers based on outcomes and changes in health status, as opposed to delivery of services.

At the January 11th, 2016 J.P. Morgan Annual Health Care Conference, Jan. 11, 2016, CMS Acting Administrator, Andy Slavitt commented that Meaningful Use criteria will soon be replaced by outcomes-based measures. Specifically, he stated, "Now that we effectively have technology into virtually every place care is med_computer_MG_7104provided, we are now in the process of ending Meaningful Use and moving to a new regime culminating with the MACRA implementation." MACRA (Medicare Access and CHIP Reauthorization Act of 2015) makes significant changes to the way Medicare pays physicians, accelerating Medicare’s shift toward value-based payments.

Measures based on MACRA include: quality, cost, use of technology and practice improvement. MACRA also replaces the traditional sustainable growth rate model for reimbursing for serviced delivered by physicians. In addition, this new focus will "move away from rewarding providers for the use of technology and towards the outcome they achieve with their patients," according to Mr. Slavitt.

This is consistent with the January 2015 announcement of CMS to set an aggressive target for transitioning to Medicare fee-for-service payments that are linked to quality, as well as those based on alternative payment models, such as accountable care organizations (ACOs). This aggressive target means that in 2018, 90 percent of the reimbursements CMS pays for health care would be through those arrangements.

This unraveling of the longstanding link between delivery of services and payment for those services (fee-for-service health care) is forcing providers and care delivery organizations to think differently about their roles and assume a level of risk that few are prepared to handle.

Under the old way of thinking, hospital-based organizations would be less likely to promote ACOs because it would likely mean a decrease in demand for acute care as patient health improves. So, care delivery organizations are facing a transition that could impact their financial viability if it is not managed effectively.

In this situation, the old adage, "if you can't measure it, you can't manage it," still rings true. We seem to be drowning in a sea of digital data. Implementation of electronic health records is almost ubiquitous. Data seems to be everywhere but the ability to quickly harness the data, understand and analyze it, then turn it into actionable information is elusive.

Analysts and programmers can help, but creating meaningful reports takes time and resources, which are usually in short supply. The ability to understand and analyze the changes in value, will define the ability to manage risk and maintain margin in this emerging environment.

The power of information must be available to health care leaders and front-line professionals, using the power of their data, in real time, to explore diagnoses, interventions, responses and changes in health status.

Practitioners and leaders in care delivery organizations can no longer afford to be restricted to submitting requests for static reports and then receive those reports without the corresponding ability to explore the data and understand what is really going on.

The SAS Analytics Framework for Health Care incorporates unparalleled expertise in data management into powerful software that encourages discovery and promotes clear, understandable and versatile deployment of that information. Users can rapidly identify relationships between variables, test assumptions, develop hypotheses and create predictive models. These capabilities used to fall exclusively within the realm of programmers and data scientists but now are readily available to those who are in the trenches.

In short, health care professionals must know what works and what doesn't . . . now. The SAS Analytics Framework for Health Care uses the latest in analytic technology to give health care professionals the insights to make more effective decisions – for the patient and the business.

Be sure to visit the SAS booth at HIMSS16 to learn more about these new capabilities in health care analytics.

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About Author

Alan Cudney

Principal Industry Consultant

Alan Cudney, RN-BC, PMP, CPHQ, FACHE, is a principal industry consultant in the Healthcare division of SAS Institute. As a registered nurse informaticist, Mr. Cudney is deeply grounded in processes and technology at the patient level. His healthcare experience of more than 30 years crosses hospital settings, managed care, disease management, outpatient psychiatry, long-term care and IT vendors. Mr. Cudney has directly staffed or led more than 40 consulting engagements, leading organizations to promote healthcare IT adoption, population health, clinical informatics, care coordination and quality improvement. The result includes multiple success stories and client testimonials. Mr. Cudney completed undergraduate work at the Florida State University and earned Master of Business Administration and Master of Health Science degrees from the University of Florida. He is also certified as a Project Management Professional, a Certified Professional in Healthcare Quality and a Fellow of the American College of Healthcare Executives. He is widely published, has presented at national conferences and has served as guest lecturer for college courses. He also serves on the Editorial Review Board of the Journal of Hospital Administration.

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