A Stoltenberg Consulting survey released in March found that two-thirds of responding healthcare providers and health information professionals are unprepared for the MACRA program, which aims to improve coordination of care and outcomes while cutting costs through value-based reimbursement.

Now, a new report from Leavitt Partners, a healthcare consulting, investment and direct services firm, walks providers through strategic considerations for MACRA success.

It won’t be easy—any provider working to transition to an Advanced APM ACO model should expect the commitment to take 18 to 24 months, according to the consultancy.

The report examines basics of the program such as scoring clinicians on quality measures, the cost of care, optimal use of electronic health records and clinical improvement with reimbursement contingent on the quality and efficiency of care delivered, and then moves into how the program will directly affect providers, with payment being the biggest impact.

Providers will need to choose between maximizing performance under the MIPS payment program that is part of MACRA, or pursuing more complex Advanced Alternative Payment Models for moving into population health management that bear more financial rewards if successful and considerably more financial risk if not.

Factors to consider when choosing an APM model, according to Leavitt Partners, include:

* The ability to operationalize certified electronic health record technology requirements

* Having or creating necessary partnerships

* An organization structure to champion value-based care, current volume of Medicare patients

* The magnitude of rewards and penalties in each type of APM

* The available APMs in the region

* Adopting prospective beneficiary assignment (list assigned at start of performance year of beneficiaries the ACO is responsible for)

* Retrospective assignment (assign patients to the ACO for the new year based on their use of services in the past year)

* Being responsible for all cost of care for a certain patient population, or only those with specific episodes of care

But that’s just the start. Off all preparations, development of the health information technology infrastructure will take the most time, Leavitt Partners warns. “A robust IT infrastructure that is interoperable with both internal and external systems, has the ability to report required model measures, and can execute actionable population management analyses is critical.”

Also See: Why information exchange issues are hampering ACO success

For now, the consultancy contends, many physicians still focus on basic EHR functions such as documentation and care coordination and don’t have sufficient reporting capability needed under MACRA.

Practice redesign will be another challenge, involving identification of areas to improve, identifying other providers to work with and making changes to patient flow. The full report is available here.

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