MACRA, Care Coordination, and Evolving Health Care Reform

Several recent reports suggest that approximately one-third of seniors rely on family members to help them coordinate their health care needs. Strikingly, another third report that no one helps them coordinate the care they receive among multiple health care providers and facilities. This lack of care coordination services is particularly troubling in light of the fact that as many as 85% of seniors have been diagnosed with at least one chronic or serious health condition, and well over half of all seniors have seen as many as three or more providers in the past year. Additionally, these health care challenges worsen with a lack of care coordination following hospitalizations or at the onset and management of serious illnesses.

Recent political transitions as a result of the presidential election have led some to question the evolving trajectory of health care reform and system transformation. However, one certainty across all health care is the fact that poor care coordination results in ineffective health outcomes and higher costs for care. Therefore, savvy providers and health systems will be wise to focus on the processes of care that result in shifts to value based payment systems that promote improved population health outcomes and reduced care costs.

One of the evolving trends in the payment for care of seniors and others is the introduction of the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). This represents a major shift in how Medicare pays providers for their services, rewarding the quality of care provided rather than the volume of services provided. The Center for Medicare and Medicaid Services (CMS) has made a strong commitment to the role of care coordination as a foundation of improved processes of care and outcomes.

A recent white paper by InfoMC (Leveraging Care Coordination Technology to Comply with MACRA) supports the role of technology solutions to promote integrated care among providers, health systems, and community based services. Changes are needed in current provider technology resources to facilitate improved care coordination among providers and across health systems to meet the evolving requirements of MACRA. According to the InfoMC white paper, “There is increasing recognition that effective health care outcomes are produced among a system of providers and community based resources. Electronic Health Records are ill suited to accommodate the care planning and communication needs of these providers. Effective coordination requires timely communication among all care team members.”

The original design of MACRA has been to impact the way in which Medicare pays for health services. It is likely that whatever the trajectory of health care reform follows, costs must be contained and quality improved. The best strategies available to impact these outcomes are to improve the way in which services are delivered, focusing on improved coordination of care and quality outcomes.   Providers and health systems would be wise to adopt strategies and resources that can promote improved coordination among all of those involved in the care of people with chronic and serious illnesses. This includes care planning and facilitated communication among providers, facilities, community based resources, and the family and other care-givers that all provide necessary services.