The 'Edge Report Blog

Why MACRA Still Matters

Participation rates of eligible providers for MIPS reporting and ACOs are above 90%, according to CMS in a blog post. It sounds good until one realizes that the goal posts of the MACRA legislation have consistently moved delaying necessary progress.

CMS initially proposed to let practices with less than $10,000 in Medicare revenue be exempt from the value-based care law, then it was $30,000 and now the threshold will be $90,000. Less than 40% of providers billing under Medicare are eligible for the program.

Still 90% of that 40% doesn’t feel like it is moving the needle to push the industry toward value-based payment reform. So, the question becomes: does MACRA matter?

Yes, it does. While progress in the shift toward value has not been as fast as most would like, the muscles the industry is collectively building and developing because of MACRA will be the thing that ultimately produces tangible results to lower costs and increase quality.

Findings from a recent survey of 73 health plan executives, sponsored by HealthEdge in association with independent research firm, Survata, show that the most important organizational goal health plans have for 2018 is to increase member satisfaction. That’s an elusive goal and often hard to achieve. Amazon CEO Jeff Bezos, no stranger to satisfying customers, says they are “divinely discontent” because “people have a voracious appetite for a better way, and yesterday’s ‘wow’ quickly becomes today’s ‘ordinary’. I see that cycle of improvement happening at a faster rate than ever before” he wrote in his recent Letter to Shareholders.

Moving toward a patient-centric system that members actually like will require health plans to become agile, first and foremost. Payers will need to invest in new services, products, and technology that allows them to move at the speed of a divinely discontent member. Health plans need technology that will enable them to make changes to plans and benefits in a matter of hours, not months. Legacy core administration systems that require six to nine months to make system changes will no longer cut it.

Transparency, data availability, convenience, and connectivity are all things members are increasingly demanding from their health insurance plans – especially as more members shift to high-deductible plans and become responsible for paying monthly premiums and the costs of their care. And those demands, as Bezos suggests, will only increase over time.

Payers will need access to real-time data to help push members to the right care setting, to help them shop for care, to track and measure important quality health factors, to do all the things members demand of them in the name of satisfaction. Payers can’t get there by resting on their laurels or doing the same old thing.

While MACRA might be taking longer to move the needle, it is the catalyst to creating lasting long-term change and organizational capabilities that will matter regardless of administration policy or legislative agenda.


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