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GE Healthcare Camden Group Insights Blog

This is the MACRA Webinar You've Been Waiting For

Posted by Matthew Smith on Oct 6, 2016 12:06:37 PM

webinar_Clouds_icon-resized-600-2.jpgPlease join GE Healthcare Camden Group for a complimentary, 60-minute webinar, Chart Your Course for MACRA Success, on Thursday, October 20, 2016, at 12:00 P.M., ET.

Background:

In April 2015, the Medicare Access & CHIP Reauthorization Act of 2015 ("MACRA") was passed, ending the Sustainable Growth Rate ("SGR") formula for determining Medicare payments for healthcare providers’ services. MACRA is intended to accelerate moving care delivery toward quality and value-based reimbursement models through the new Merit-Based Incentive Payment System ("MIPS") and incentive payments for participation in certain Alternative Payment Models ("APMs").

This law has a strict timeline to implement strategy to maximize possible incentive payments, improve care delivery and design, and successfully achieve efficiencies improving cost and quality that will go into effect 2019 based on the 2017 performance reporting period. While the final details of the incentives for the new payment models will not be defined until CMS publishes the final rule in November 2016, there are several things you can begin doing to determine optimum strategy and prepare for 2017.

Overview:

In this complimentary webinar, members of the GE Healthcare Camden Group consulting team will deliver an overview of the legislative details of the new payment reform law and the implications of MACRA. They will also provide the necessary tools to successfully navigate through the next phase of participation for the Quality Payment Program, MIPS, and APMs.

Date:

Thursday, October 20, 12:00 P.M., Eastern

Learning Objectives:

  • Learn the timing and timeline for MACRA implementation
  • Review the two tracks for participation, APMs and MIPs
  • Examine the incentives and penalties associated with MACRA
  • Gain insight on MIPs Composite Score:
  • Understand what it will take to be successful under MACRA
  • Master the steps to take to begin the path to APMs

GE Healthcare Camden Group Presenters:


Burnett_new.jpgSabrina Burnett, Vice President

Ms. Burnett is a vice president with GE Healthcare Camden Group. With more than 20 years of professional experience, Ms. Burnett delivers a wealth of skilled leadership in health management processes and solutions-based planning and execution. She has in-depth knowledge of the post-acute industry and a thorough understanding of the healthcare market, payer reimbursement methodologies, including managed care requirements and strategies, and knowledge of relevant state and federal regulations and actions. Ms. Burnett is recognized for her expertise in contract negotiations, solutions-based planning.

Hawkins_New.jpgCami Hawkins, Manager

Ms. Hawkins is a manager with GE Healthcare Camden Group and has more than 20 years of experience in the healthcare provider sector as a management consultant. She specializes in the areas of practice operations, contract negotiations, benefits administration, reimbursement management, and market development. Ms. Hawkins assists a wide range of provider organizations, healthcare systems, and independent and employed physician groups with addressing issues impacting their overall performance and competitive positioning. Her key areas of expertise include strategic planning, population health strategy.

ZielinskiL.jpgLucy Zielinski, Vice President

Ms. Zielinski is a vice president with GE Healthcare Camden Group. With over 25 years of experience in the healthcare industry, she specializes in helping private and hospital-owned medical groups achieve top financial and operational performance. Such optimization is achieved through physician-hospital alignment—including clinically-integrated networks, strategic planning, practice transformation, coding and revenue cycle improvement, physician compensation plan design, and health information technology, and data analytics optimization.

To Register:

To register, simply click the button below, complete a short registration form, and press the "Cick to Register!" button. We will provide dial-in information and a WebEx link via email the week of the webinar.

Webinar, MACRA Questions?

Please contact Matthew Smith at msmith@ge.com.

Topics: Webinar, Lucy Zielinski, MACRA, Sabrina Burnett, Cami Hawkins, MIPS, APM

Making Sense Out of MACRA and Alternative Payment Models

Posted by Matthew Smith on Aug 4, 2016 3:57:47 PM

By Sabrina Burnett, Vice President, and Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

MACRA_Image.pngProviders may have developed a false sense of security that time is on their side—MACRA does not start until 2019, right?  While 2019 is the official date for the new payment models, performance beginning January 1, 2017, will determine 2019 payment adjustments.

CMS published the proposed rule defining their intentions under the new Quality Performance Program on May 9, 2016, and accepted comments on the proposed rule until June 27, 2016. CMS is expected to release the final rule by November, but their goal has remained firm: move 80 percent of Medicare payment to alternative payment models (“APM’s”) by the year 2020.

Path of Advanced APMs

While it may make sense for the majority of providers to initially go down the path with Merit-Based Incentive Payment System (“MIPS”), here is the critical information providers should know if they plan to participate in an Advanced APM.

MACRA outlines significant incentives to encourage providers to participate in Advanced APMs, including a 5 percent bonus starting in 2019 and an exemption from MIPS. The Advanced APM program, unlike MIPS, has no potential penalties. However, participation will not come easy. CMS set the standard high and challenges providers to satisfy the Advanced APM criteria.

  • Advanced APMs require providers to accept risk for delivering coordinated, high-quality care. As proposed, Advanced APM models must be a CMS Innovation Center model, a Medicare MSSP ACO, a demonstration under the Health Care Quality Demonstration Program, or a statutorily required demonstration and must meet the following additional requirements:
    • Utilize certified EHR technology
    • Report quality measures comparable to MIPS measures
    • Assume more than nominal financial risk

Initially only the following five Advanced APMs will be recognized under the new rule:

  • Medicare Shared Savings Program (“MSSP”) (Track 2 and Track 3)
  • Next Generation ACO Model
  • Comprehensive Primary Care Plus
  • Comprehensive ESRD Care Model
  • Oncology Care Model

Exclusions Apply

To the dismay of some, three programs have been excluded:  MSSP Track 1, Comprehensive Care for Joint Replacement (“CJR”), and Bundled Payments for Care Improvement (“BPCI”).

CMS will add new payment models and continue to modify models in coming years that satisfy the criteria to qualify as an Advanced AMP. Until 2021, participation requirements for Advanced APMs are only for Medicare payments or patients.

If your organization is trying to determine if moving to an Advanced APM makes sense, you should conduct an organizational self-assessment to identify current capabilities and those still needed to achieve status as an Advanced APM. It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful.

Key Considerations

  • Do you have progressive financial and clinical data analytics and reporting capabilities?
  • Are you prepared to invest in technology and care model redesign to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance?
  • Do you understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where and how providers will be incentivized to achieve these objectives to produce improvements in care coordination and quality?

There is not a one-size fits all strategy, so it is important to know your readiness to participate in an Advanced APM, the different care delivery needs of the community, the scope of risk to be taken, and have the infrastructure in place that will be necessary to achieve success.

MACRA APM


sabrina_burnett1.pngMs. Burnett is a vice president with GE Healthcare Camden Group. With 20 years of professional experience, Ms. Burnett delivers a wealth of skilled leadership in health management processes and solutions-based planning and execution. She has in-depth knowledge of the post-acute industry and a thorough understanding of the healthcare market, payer reimbursement methodologies, including managed care requirements and strategies, and knowledge of relevant state and federal regulations and actions. She may be reached at sabrina.burnett@ge.com

 

MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at marc.mertz@ge.com.  

 

 

Topics: Marc Mertz, MACRA, Sabrina Burnett, Alternative Payment Models, APM

Preparing for Value-Based Contracting? Here are 5 Key Questions for Providers to Consider

Posted by Matthew Smith on Jun 7, 2016 2:27:10 PM

By Sabrina Burnett, Vice President, GE Healthcare Camden Group

contracting.pngIn January, 2015, the U.S. Department of Health and Human Services ("HHS") announced it had set a clear goal and timeline for transitioning Medicare reimbursements from volume to value. HHS’s goal is to tie 30 percent of all Medicare payments to quality and cost performance by the end of 2016 and increasing that proportion to 50 percent by the end of 2018. Commercial payers are expected to follow suit and develop their own programs for basing payment on quality or value. Immediately following the announcement from HHS, several major health systems and the nation’s top health insurers announced the creation of the Health Care Transformation Task Force and challenged other providers and payers to commit to their goal of putting 75 percent of business into value-based arrangements by 2020¹.

It is no longer a matter of “if” we are moving to value, but “when." As providers prepare for impending change in reimbursement they must decide if they are going to lead, follow or resist.

5 Considerations

Regardless if providers are planning to engage in shared savings, accountable care organizations, bundled payments, or risk contracts, there are several questions to consider when developing their strategy: 

  1. Are you prepared to participate in value-based initiatives?
  2. Do you understand the healthcare needs in your market?
  3. Have you optimized the technology necessary to support success?
  4. Have you undergone care delivery transformation?
  5. Do you understand the financial implication of new reimbursement methods?

It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful in a value-based world. Conduct an organizational self-assessment to help identify current capabilities and those still needed to achieve status as a value provider. Additionally, catalog the existing payers, products, and value-based programs and know the health care needs in your market and the corresponding services offered. Knowing your capabilities and understanding your market serves as a blueprint or roadmap to develop your strategy and guide successful contracting efforts. As you begin to build the payer strategy, it is important to stay focused on what infrastructure/tools you need to possess or build to effectively manage risk while reducing costs of care and maintaining high-quality outcomes. 

Analytics Drive Positioning

To properly position for value-based care, providers must have progressive financial and clinical data analytics and reporting capabilities. Significant investments in technology and care model redesign are required to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance. Payers have massive amounts of data and an infrastructure to collect, aggregate, and analyze the data. Look for payers that are willing to collaborate and work in partnership to leverage the data and infrastructure.

It is equally important to invest the time to understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where, how individual participants will be incentivized to achieve these objectives and the short-term investment in the infrastructure required to produce improvements in care coordination and quality.

There is not a one-size fits all strategy, so it is important to know the provider’s readiness to participate in value-based initiatives, the different care delivery needs of the community, the scope of risk to be taken, and have relationships with payers and other providers that will be necessary to achieve success.

1. Source: “Major Healthcare Players Unite to Accelerate Transformation of U.S. Healthcare System” Health Care Transformation Task Force, June. 28, 2015.


sabrina_burnett1.pngMs. Burnett is a vice president with GE Healthcare Camden Group. With 20 years of professional experience, Ms. Burnett delivers a wealth of skilled leadership in health management processes and solutions-based planning and execution. She has in-depth knowledge of the post-acute industry and a thorough understanding of the healthcare market, payer reimbursement methodologies, including managed care requirements and strategies, and knowledge of relevant state and federal regulations and actions. Ms. Burnett is recognized for her expertise in contract negotiations, solutions-based planning and post-acute integration within the continuum of care. She may be reached at sabrina.burnett@ge.com

Topics: Value-Based Contracting, Healthcare Data, Provider Contracting, Sabrina Burnett, Healthcare Data Analytics, Volume-to-Value

5 Key Considerations for Providers Preparing for Value-Based Contracting

Posted by Matthew Smith on Nov 6, 2015 9:35:28 AM

By Sabrina Burnett, Vice President, The Camden Group

Value-Based Contracting, PhysiciansOn January 26, 2015, the U.S. Department of Health and Human Services ("HHS") announced it had set a clear goal and timeline for transitioning Medicare reimbursements from volume to value. HHS’s goal is to tie 30 percent of all Medicare payments to quality and cost performance by the end of 2016 and increasing that proportion to 50 percent by the end of 2018. Commercial payers are expected to follow suit and develop their own programs for basing payment on quality or value. Immediately following the announcement from HHS, several major health systems and the nation’s top health insurers announced the creation of the Health Care Transformation Task Force and challenged other providers and payers to commit to their goal of putting 75 percent of business into value-based arrangements by 2020¹.

It is no longer a matter of “if” we are moving to value, but “when." As providers prepare for impending change in reimbursement they have to decide if they are going to lead, follow or resist.Considerations

Regardless if providers are planning to engage in shared savings, accountable care organizations, bundled payments or risk contracts, there are several questions to consider when developing their strategy: 

  1. Are you prepared to participate in value-based initiatives?
  2. Do you understand the healthcare needs in your market?
  3. Have you optimized the technology necessary to support success?
  4. Have you undergone care delivery transformation?
  5. Do you understand the financial implication of new reimbursement methods?

It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful in a value-based world. Conduct an organizational self-assessment to help identify current capabilities and those still needed to achieve status as a value provider. Additionally, catalogue the existing payers, products, and value-based programs and know the health care needs in your market and the corresponding services offered. Knowing your capabilities and understanding your market serves as a blueprint or roadmap to develop your strategy and guide successful contracting efforts. As you begin to build the payer strategy, it is important to stay focused on what infrastructure/tools you need to posess or build to effectively manage risk while reducing costs of care and maintaining high-quality outcomes. 

Analytics Drive Positioning

To properly position for value-based care, providers must have progressive financial and clinical data analytics and reporting capabilities. Significant investments in technology and care model redesign are required to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance. Payers have massive amounts of data and an infrastructure to collect, aggregate, and analyze the data. Look for payers that are willing to collaborate and work in partnership to leverage the data and infrastructure.

It is equally important to invest the time to understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where, how individual participants will be incentivized to achieve these objectives and the short-term investment in the infrastructure required to produce improvements in care coordination and quality.

There is not a one-size fits all strategy, so it is important to know the provider’s readiness to participate in value-based initiatives, the different care delivery needs of the community, the scope of risk to be taken, and have relationships with payers and other providers that will be necessary to achieve success.

  1. Source: “Major Healthcare Players Unite to Accelerate Transformation of U.S. Healthcare System” Health Care Transformation Task Force, June. 28, 2015.

Ms. Burnett is a vice president with The Camden Group with more than 20 years of professional healthcare experience. She specializes in physician services solution-based planning and execution. Ms. Burnett has in-depth knowledge of the post acute industry and a thorough understanding of the healthcare market, payer reimbursement methodologies, managed care requirements and strategies, and knowledge of relevant state and federal regulations and actions. She also has extensive operational experience with credentialing, billing and collections, practice management, assisting billing companies and medical groups in improving their financial performance. She may be reached at sburnett@thecamdengroup.com or 512-792-5600.

Topics: Value-Based Contracting, Provider Contracting, Sabrina Burnett

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