Time to Move Beyond Meaningful Use & MACRA

Publication Date: 27/01/2017

Written by

Alex Green

Meaningful Use targets set by the Centers for Medicare and Medicaid Services (CMS) have served a purpose in rapidly bringing patient engagement and population health management (PHM) to the forefront of the US healthcare industry. However, providers, payers, employers and consumers have a huge amount more to gain if, and when, the use of these platforms moves beyond the box-ticking exercise of hitting Meaningful Use and MACRA targets.

Here’s our take on why:

The Signify View

The modern healthcare consumer in the US is used to having choices. In banking, retail, travel, and most other walks of life, product or service information is abundant and decisions are made quickly, based on price, convenience, reputation and quality. Increasingly, consumers are approaching healthcare with a similar attitude. They want to be able to compare the quality of the service they’ll receive, view feedback from other service users, manage appointments online, understand the cost implications of medical procedures, contribute their heath data to the decision-making process and be able to easily communicate electronically with providers.

At the same time health providers are under pressure to adapt to this new, consumer driven healthcare market environment. They need to be able to address the demands of this consumer-centric approach to healthcare and provide the improved cost transparency, greater convenience, better communication tools and a wider set of service information for the patient.

A Convergence of Demand

The solution from both perspectives, can be provided by population health management platforms and patient engagement platforms, the latter often being implemented as a component of the former. Patient engagement platforms provide both the consumer and provider with a vehicle for improving the communication channels. They provide consumers with the information and the service access they need to obtain the information they’re demanding, while also giving providers a strategic tool to retain existing customers and roll out initiatives that result in much more comprehensive care management solutions for the population they’re serving.

However, many implementations of PHM and patient engagement platforms are not yet addressing these requirements, instead they are just being used to hit CMS targets around reimbursement.

Following purely a MACRA adherence strategy, a clinician can hit their CMS targets for patient access by ensuring that one of their patients interacts with their patient portal once during a three month period over 2017. Or similarly they can hit their patient education target by providing one patient over the three month period with targeted education material via their EHR. This will allow them to take a step towards receiving full reimbursement. But it doesn’t touch any of the issues outlined above and only scrapes the surface of what they otherwise could have achieved from the investment made in the enabling platform. A big missed opportunity!

Reducing Healthcare Costs

As well as having to address the increasingly consumer-centric nature of the healthcare industry, providers are also grappling with the move to value-based care and an overall agenda of better managing costs.

The strategy often employed to address this is via Accountable Care Organizations (ACOs). These can be physician led, hospital led, and even payer-led, but at their core is the objective of better managing the health of a whole population in order to control costs.

Population Health Management platforms are again the central tool employed to achieve this. These platforms provide:

  • The risk stratification solutions and analytics that can be used to target and pinpoint which patients within the population are those that are most likely to develop a long-term condition, or for those already managing long-term conditions which are most likely to be admitted or re-admitted to hospital.
  • The care management/care coordination tools that pull data together from disparate sources and provide multi-disciplinary care teams with a central tool to coordinate care across these populations.
  • The patient engagement tools that allow for providers and consumers to easily interact, share health data, provide reminders for screenings, allow for online appointment booking, provision remote health monitoring and allow for greater management of care costs.

The meaningful use, and future MACRA Advancing Care Information (ACI) targets around patient education, portal access, care transitions and patient generated health care started to encourage the use of population health management platforms as described above. But again, following a strategy based purely on hitting meaningful use or MACRA targets will not address this drive to manage the cost of providing healthcare for a given population. ACOs and providers need to instead embrace a much broader strategy when employing their PHM solution, one that goes well beyond these legislative targets.

Times Are Changing

Signify Research’s view is that ACOs, providers and payers do understand this, and they have now started to move on from their initial deployments. For many organisations the investment in technology has been made, it’s the re-engineering of processes that are now required in order to fulfil the technology’s potential. Over the coming years we’ll see greater use of the full range of features offered that address the demand driven by the consumerisation of health and the need to better manage health care costs.

This is good news for all. For the consumers demanding a healthcare experience that provides the choice, information, control and transparency they’re used to seeing elsewhere; for the providers and ACOs implementing strategies to support their move to better manage unforeseen financial risk, and of course to the vendors of these platforms.

New Market Report from Signify Research Publishing Soon

A full analysis of these issues will be provided in Signify Research’s upcoming market reports ‘Population Health Management – North America Market Report 2017’, publishing in March 2017, and ‘Population Health Management – EMEA, Asia & Latin America Market Report 2017’, publishing in June 2017. For further details please contact Alex.Green@signifyresearch.net.