MACRA patient engagement cheat sheet No. 1 — Leveraging patient engagement for MACRA success: An overview

With the release of the Medicare Access and CHIP Reauthorization Act final rule last month, the move toward pay-for-performance has crossed a Rubicon. No longer a theoretical concept or something to worry about in some distant future, it is something you need to plan for now. MACRA contains multiple programs impacting virtually every facility, service line, department and role within your organization, so it’s easy to forget to enlist the help of patients in your efforts. Leaving out the patient would be like throwing a birthday party and not inviting the birthday boy or girl.

This is the first article in a series that will dive into detail about how you can use technology to engage and empower your patients in ways that will help you succeed however you plan to respond to the new requirements of MACRA. This article shows how patient engagement is generally applicable across the various MACRA programs, while the articles that follow will explore individual programs, including Merit-based Incentive Payment System, ACOs/MSSP, bundled payments and medical home.

The requirements for patient education, patient electronic access to health information, and secure messaging are the minimum, mandatory patient engagement requirements of MACRA and it would be easy to think that meeting them would be sufficient. Doing so, however, would overlook great opportunities to improve your organization’s performance across virtually every MACRA domain. These specific patient engagement measures exist within meaningful use and MACRA because there is substantial evidence that improvements in these areas support improved clinical and financial outcomes. Therefore, organizations should view these requirements in terms of their strategic intent, not just narrowly as a set of arbitrary and meaningless criteria to be met as minimally as possible.

Beyond meeting the explicit patient engagement requirements, the next most obvious way to leverage patient engagement as part of your MACRA strategy is based on the fact that almost all of the MACRA programs include some patient satisfaction criteria. More and more, patients are seeking 24/7 access to their health information, curated educational resources and tools that empower them to participate in their healthcare. They also want to communicate with providers without having to make in-person appointments. Lastly, they want more convenient ways to perform basic administrative interactions, such as scheduling appointments and viewing and paying bills. Delivering these tools can not just improve patient satisfaction scores, but also improve efficiency and make patients more loyal to your organization.

Across virtually every MACRA domain and program are payment-impacting criteria that can be dramatically affected by patient behavior. Your substantial investments in improved clinical workflows and evidence-based care protocols can quickly be forfeited due to a patient’s failure to follow critical follow-up instructions. Therefore, to protect these investments, make a small marginal investment in tools that can improve patient compliance, such as automated reminders, connected devices that make self-maintenance more convenient and better education so they understand what they can do to improve their health and what the costs of not doing so might be.

Another key aspect of patient engagement where small investments can pay dividends across a wide variety of MACRA programs is using technology to get to know your patient better. By gathering patient preference, behavior and home-based health readings, you can gain better insights at both the population health and individual level. These insights can inform and improve prevention efforts to avoid costly procedures that will hurt MACRA scores and help you to identify patients with poorly self-managed chronic diseases that need additional attention. Remote monitoring of patients through connected devices can also provide early warnings, allowing your healthcare professionals to intervene and assist a patient to get back on track before a costly and preventable acute episode occurs.

One thing these different patient engagement approaches have in common is that they all involve patient health data that does, or should, already exist in other systems. You want to make sure your patient-engagement platform supports standards such as HL-7, InfoButton and common vocabularies to facilitate interoperability. Allow data to flow between your patient engagement system, your clinical systems, and your analytics system, to provide better information for better decisions across your organization.

With all the complexity of the various MACRA programs, you may be feeling overwhelmed. CMS has softened the impact of MACRA for 2017. Therefore, you should maximize your ROI by focusing on a strategy for 2018 and beyond rather than rushing a short-sighted plan into action immediately. Patient engagement may seem like an unnecessary distraction, but small and incremental investments can pay off in big ways. Just as it pays to coordinate other IT initiatives between different MACRA programs, coordinating your patient engagement efforts can greatly improve efficiencies.

Here are five steps to get started on engaging patients to support your MACRA strategy:

1. Bring together the appropriate stakeholders within your organization
2. Educate yourself (including reading the rest of this series!)
3. Examine the capabilities of your existing systems
4. Seek outside expertise, if appropriate
5. Plan comprehensively but implement incrementally; don’t try to do everything at once





Mr. Heaney is a founding partner of Get Real Health.





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