The vast majority of healthcare professionals are current on the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015’s Merit-based Payment System (MIPS) and believe they are able to meet its core requirements, according to recent survey results. Those core requirements, at least in the initial years of the MIPS program, heavily focus on care quality metrics.
The success on this key MIPS category relies on providers’ ability to engage their patients so they adhere to their treatment plan requirements, while also making other positive choices about their health. Fostering this engagement is a two-way street: Patients need to follow providers’ recommendations, but providers should also play their part by initiating clinical interventions before the patient knows they need to act.
Delivering a more intensive level of preventive care support in this way can be time-consuming for care managers and also ineffective if the outreach is not targeted. Technology-enabled population health management (PHM) workflows can overcome these obstacles by helping providers both anticipate outcomes and automate outreach to encourage positive behaviors.
The results are a stronger MIPS quality category performance, as well as treatment plan adherence and reduced healthcare costs, which benefits the organization regardless of its value-based care program.
Population health management gap in MIPS participants
A recent survey of more than 800 healthcare professionals conducted by InteliChart shows 90 percent of participants believe they are up-to-date on all MIPS and MACRA legislation as it pertains to them. Likewise, nearly 90 percent believe they can not only meet but are outperforming beyond the MIPS requirements.
Fundamentally though, success in MIPS or any value-based care program rests in not just understanding and fulfilling narrow requirements, but rather on providers’ ability to manage populations across all risk profiles. After all, today’s moderate-risk patient can be tomorrow’s high-risk patient. In this regard, almost 80 percent of survey participants reported they have technology necessary for PHM.
Initiating interventions is crucial to improve quality and MIPS performance, but also to strengthen patient engagement that leads to long-term quality-metric and cost-performance gains. To be engaged and follow treatment plans, patients must understand their care path and know they can trust their providers. Reaching out to patients who are more likely to stray from treatment plans, or not respond to prescribed protocols, nurtures that trust and deepens engagement.
Data drives automated interventions
Providers rely on data in their electronic health record (EHR) to conduct the analysis that can help them predict patient behaviors and outcomes. Numerous other data sets, including many non-clinical sources, are available that can aid in more accurate predictions and precise interventions. For example, data on patients’ nearby relatives, home address change frequency, car ownership and many others can be incorporated into sophisticated algorithms that help predict behaviors and outcomes.
A care manager can then use those analytic capabilities to stratify these patients into risk categories for more frequent interventions. Patients at varying risk levels for acquiring Type-2 diabetes, for instance, may need different levels of support from their provider to help them make the healthcare and lifestyle choices to better manage their health and improve their outcomes.
Automating these patient notifications and communications through real-time analytics available in PHM technology can help care managers intervene with those patients more efficiently and effectively. The technology can even help coordinate care between numerous providers so patients receive the care they need faster and on their desired schedule, which also builds engagement.
Such targeted outreach alleviates effort for both patients and providers, which means provider organizations can reduce their care costs, increasing MIPS Composite Performance Score (CPS) and financial returns under the program.
Integrated technology essential
Frequently, the challenge of conducting effective outreach is combining, normalizing and analyzing data sets from all provider organizations along with the new data sources to initiate targeted interventions. It would be challenging enough if hospitals, health systems and ACOs were all technologically aligned, but most often, they use EHRs and other information systems from multiple vendors, including internally developed software.
Implementing PHM technology that can be seamlessly integrated across multiple EHR systems and other platforms eliminates those obstacles. This level of integration helps ensure that accessing data from the PHM platform from anywhere across the enterprise is non-disruptive for providers. Such ease of access and operation can also encourage adoption among physicians and stronger engagement for patients.
Physician adoption is further enhanced because the intelligence derived from the PHM technology will be based enterprise-wide, real-time data, so it is more reliable and actionable. Thus, care managers can confidently and proactively conduct outreach and communicate with patients.
Most importantly, frequent communication and interaction with patients nurtures the trust and empowerment that is so essential for engagement. Whether it is for MIPS or any value-based care program, deeper engagement will lead to better outcomes and stronger financial performance.
About the author:
Gary Hamilton is chief executive officer of InteliChart
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.