Staying Focused in a Time of Uncertainty in Healthcare

by | May 12, 2017 | Grow Article |

With the passage of the American Health Care Act (AHCA) in the House of Representatives on May 4, 2017, there’s no shortage of speculation and uncertainly on the potential impact, both positive and negative, of changing healthcare legislation.

Since the passage of the Affordable Care Act in 2010, the healthcare industry and the health plans, hospitals, health systems, and providers that make it work, have been in a constant state of transition and uncertainty. For many in the industry, the first steps towards the possible full passage of the AHCA creates yet another wait and see moment.

While the AHCA may have significant impact on the insurance exchange and overall healthcare marketplace, the law as written does not change the trajectory of many critical value-based payment models that were established with the Medicare Access & CHIP Reauthorization Act (MACRA).

Support for MACRA is Still Strong

MACRA was passed in April 2015 with strong bipartisan support, and still has strong support. Within MACRA are multiple value-based payment models which qualify as Advanced Alternative Payment Models (APMs).

This includes episodes of care/bundled payments, Accountable Care Organizations (ACOs), Comprehensive Primary Care Plus (CPC+), and other alternative payment models that fall under the Merit-based Incentive Payment System (MIPS) reporting path. Changes to these payment models are not part of the current AHCA as written today.

MACRA was passed to support the goal of moving to quality and value-based payment contracts. The Department of Health and Human Services (HHS) set and published goals of tying 85 percent of Medicare fee-for-service payments to alternative payment models, such as ACOs, CPC+, and episodes of care, by the end of 2018.

We are well on the healthcare reform journey. Those that stay focused will be successful.

Don’t Just Survive – Thrive

With the ongoing transition to value-based payment models, health plans, hospitals/systems, and physician groups have been forced to quickly adapt to a changing way of both delivering care and doing business.

Long-standing payment models tied to treatment rendered are fading, putting pressure on organizations to adapt to payment models based on quality and outcomes, bundled payments, and shared savings.

For many, this transition has stifled growth and forced a choice between volume OR value. Many organizations struggle financially, and are cutting resources and consolidating services. At Navvis we view the transition to alternative payment models and MACRA as an opportunity to thrive and take market leadership.

Who doesn’t want to partner with, work for, or visit the hospital or health system that delivers superior care at a lower cost? At Navvis we call this the power of volume AND value, volume-based growth through value-based performance.

Embracing New Payment Models

Significant growth and diversification opportunities exist within episodes of care, ACOs, and other alternative payment model contracts that will remain through MACRA. Unlocking these opportunities starts with building an integrated strategy, operational model, and technology platform that will deliver high-quality, cost-efficient care.

It’s more than just trying to meet a quality score, or trying to retain some revenue from a bundled payment. It’s about aligning an entire healthcare organization to effectively manage the individual care needs and cost of care for each patient across all settings; pre-acute, acute, and post-acute.

By embracing the transition to value-based payment models, and building a care model that is value-generating for all stakeholders (including patients and physicians) healthcare organizations will set themselves apart from the competition, capture new sources of clinical and financial value, and establish a foundation for growth.

The path toward quality and value-based payment models is firmly rooted, and organizations at-risk for the overall health and cost of patient populations need to continue to be proactive, forward thinking, and strategic to be successful. There is more at stake than just getting paid.