MACRA: The Risk-Savvy Approach

Atrius Health has a long track record of being measured on quality. The system is expecting that experience to pay off.

Physician groups, particularly small practices, have raised many concerns about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

MACRA, the End of Meaningful Use, and Beyond

Still, some organizations, particularly those with an appetite for risk and the skills to manage it, will be ahead of the curve.

I spoke recently with Marci Sindell, chief strategy officer and senior vice president of external affairs for Massachusetts-based Atrius Health, about the lessons the system has learned so far about value-based care and how it will apply to MACRA.

The following transcript has been edited lightly.

HealthLeaders Media: With your longtime experience bearing risk, how well prepared do you feel to comply with MACRA? Will any of your groups qualify as an alternative payment model (APM) in the first reporting year?

Sindell: For Atrius Health being measured on a wide range of quality metrics in payer contracts, [and achieving] compliance with MACRA will not be very difficult. As a Medicare Pioneer ACO since 2012, we have a strong track record of scoring in the 90th percentile nationally in quality. We expect to participate in NextGen, so we will qualify as an APM in the first reporting year. 

HLM: How have you so far educated and engaged your employed physicians around the changes coming with MACRA?

Sindell: Our employed physicians have been well educated in population health management over the years, and are very engaged in quality improvement.

Importantly, Atrius Health has built systems to support high achievement for each quality measure. This means being able to identify the population of patients who are included for each measure, doing outreach to ensure that process measures are achieved, and reporting to identify those who are not achieving outcome goals so that additional outreach using defined protocols can improve their health. 

HLM: How might MACRA complement (or challenge) your existing initiatives around population health and providing high-quality, high-value care?

Sindell: The volume of work to support 33 or more metrics makes it literally impossible for a physician to do all of this on their own and ensure the process reliability that is needed to achieve high quality.

But patients deserve no less. At Atrius Health, physician leadership has built much of this into our EMR, with physicians supported by medical assistants who do screening, population health managers and case managers for outreach, and nurses, nutritionists, and other clinicians to support treatment.

Finally, we are making joy in practice a top priority and are seeking systematic efficiencies by improving EMR efficiency and offloading population health management tasks from physicians.

This will help primary care physicians use their important cognitive skills to treat the issues that cannot be managed by protocol and to build lifelong personal relationships with their patients.

HLM: What insights do you have to share with other organizations about transitioning toward value?

Sindell: MACRA was designed to have winners and losers as it relates to payment. Physicians with lower documented quality will fund bonuses for others with high quality.

For organizations of any size just starting on this journey, the challenge is to put this in place for 2017 measurement (assuming MACRA stays on schedule), along with infrastructure to report the metrics to CMS to be successful when MACRA kicks in.

We anticipate that smaller, independent physician groups will find it difficult to do this on their own, and that there will be consolidation as physicians strive to be among the MACRA winners. That may not be a bad thing. Competition will drive standards higher and improving health outcomes more consistently is likely to be the result.

Sometimes it takes a village.