Curtis Lowery, M.D., has a passion to help deliver the highest quality healthcare to all Americans, no matter their physical location.
Dr. Curtis Lowery to Share Innovative Telehealth Best Practices at Telemed Leadership Forum in Washington, DC
Catalyst Health Network: Achieving URAC Accreditation Wasn’t Easy, but the Process Made Us a Better Organization
A commitment to patient safety and pride in its physician network inspired Catalyst Health Network (Catalyst) to devote time and resources to achieving URAC Clinical Integration Accreditation in December. It wasn’t always an easy journey, but there was never any doubt it was worth it, said Christopher Crow, MD, president, Catalyst.
[Interactive Infographic] Explore Four Strategies by Clinically Integrated Networks to Succeed in Today's Healthcare Economy
This interactive infographic on How Four Healthcare Organizations Became Clinically Integrated Networks explores the strategies used to achieve success and how accreditation helped these organizations build and improve their CIN framework.
WASHINGTON, DC – January 8, 2018 – Telemedicine Magazine and telehealth accreditor URAC will co-host the “Telemed Leadership Forum 2018: ROI of Telehealth,” March 27 – 29, 2018, at the Renaissance Washington, DC. The national telehealth conference features 30+ telehealth experts who are executives and physician leaders from health systems, health plans, academic medical systems, and telehealth providers. The conference is also being offered as a live streaming webcast. For more information, visit telemed.org.
America is suffering from a national healthcare crisis. Opioids have become a scourge, cutting a wide and fatal swath through small towns, rural areas, and, increasingly, larger cities across the United States.
URAC’s New Industry Insight Report Reveals Proven Strategies from Healthcare Organizations to Improve Transitions of Care
While there’s no single magic bullet to improve care transitions, healthcare providers and health plans have succeeded in addressing some primary causes of avoidable complications and readmissions to help patients move safely to the next care setting.
[Video] How URAC Accreditation Helps Clinically Integrated Networks Create a Comprehensive Roadmap to Avoid Compliance Pitfalls, Reduce Costs and Improve Patient Care
This 72-second animated video explains how URAC’s Clinical Integration Accreditation program helps networks ensure they are in compliance with antitrust laws, demonstrates to health plans that they’re on track to achieve quality goals, and shows regulators that policies and procedures meet national standards.
For Avizia Chief Executive Officer Mike Baird, becoming the first telehealth provider to achieve URAC telehealth accreditation is about more than demonstrating his organization’s commitment to delivering the highest level of quality. It’s also about promoting the entire concept of telehealth in the minds of patients and providers.
The healthcare community is strongly supportive of performance measures to further improve care quality, but remains wary because they want to be tracked in a “fair and transparent way by measures that provide useful information for consumers and for quality improvement,” Marybeth Farquhar, PhD, MSN, RN, and URAC’s vice president of quality, research, & measurement, told attendees of a recent webinar, “The Politics of Performance Measurement.”
Specialty pharmacies can enhance patient care, serve more customers, and expand the provider network if they pursue accreditation with an across the board commitment and a clear understanding of goals, says Heather Bonome, URAC director of pharmacy.
“Think of it as a way to organize and demonstrate your commitment to quality,” she says in a new podcast, “Pharmacy Accreditation: A URAC Perspective”, hosted by Christopher W. Kennedy, MSM, chief operating officer, Heritage Biologics, Inc.
America’s military veterans deserve the very best medical services we can provide – and accreditation should play a key role in ensuring they receive the highest possible standard of healthcare, says Dr. Kevin Galpin, executive director, Telehealth Services Office of Connected Care, Veterans Health Administration at the U.S. Department of Veterans Affairs (VA).
The benefits of URAC Clinical Integration accreditation are crystal clear to Ginger Hines, the new senior director of operations at the Seattle Children’s Care Network (SCCN).
When Hurricane Harvey slammed into Houston in August, pounding the city with powerful wind gusts and several inches of rain, Community Health Choice (CHC) was ready. “I’ve lived through three hurricanes,” says native Houstonian Delwin Beene, director of accreditation at CHC. “This wasn’t our first time at the rodeo.”
It is an old but true adage that government moves slowly. While change may be swift, your local, state, or federal regulator is not.
Washington, DC -- The New York State Office of Mental Health (OMH) has announced that it will accept telehealth accreditation as evidence of regulatory compliance for part of the state’s telepsychiatry requirements.
St. Vincent’s Health Partners: How URAC’s Clinical Integration Accreditation Program Helps Us Build an Internal Structure that Supports Success
Achieving URAC’s Clinical Integration Accreditation has resulted in many unexpected efficiencies and improvements for St. Vincent’s Health Partners (SVHP). But not just clinically.
Each year, NAIRO and its members stage an annual Symposium discussing the latest developments and trends in independent medical review. The Symposium delivers in-depth educational content, along with networking opportunities to meet and exchange ideas. The theme for the three-day event is "Trust in Healthcare," highlighting security, regulatory, and legal topics as IROs work in a changing healthcare environment.
Telehealth is a promising new avenue for providing greater access to care for countless patients. However, not all healthcare organizations are ready to press forward on a fully developed program.
Robust measurement and accreditation programs are key components of a successful telehealth program, leading experts say.
When New York-based Westchester Medical Center Health Network (WMCHealth) decided in 2015 to launch a telehealth program across its 6,200-square-mile service area, the 10-hospital network opted to build it from scratch, investing more than $7 million in technology and infrastructure.
With the transition to value-based healthcare and the growth of Accountable Care Organizations (ACOs), healthcare providers and payers are looking for ways to overcome barriers to meeting population health goals.
While CINs enable health systems and providers to deliver value-based care, they come with many clinical and operational challenges, including in those related to technology, governance, organizational alignment and care coordination. And there are very real compliance threats. The U.S. Federal Trade Commission, Department of Justice and state regulators closely scrutinize the structures of these networks to safeguard against antitrust violations.
Change is a part of every quality improvement initiative, and leadership is essential to the endeavor. Thought leader Don Berwick, M.D. stated that the failure to move the quality agenda forward was due to the failure of leadership and the inability of medical administrators and the professional workforce to innovate (Galvin, 2005).
The telestroke program at Penn State Hershey Medical Centers (PSHMC) has dramatically improved care for stroke victims and sets a high bar for other organizations looking to follow suit.
As the saying goes, the more things change, the more they stay the same. Healthcare is no exception. Quality and accountability are two buzzwords that began in the latter half of the 2000s and intensified with the passage of the Accountable Care Act in 2010.
Hundreds of healthcare leaders will gather at the Renaissance Washington, DC to get insights from more than 27 speakers at the Telemed Leadership Forum 2018: ROI of Telehealth, March 27 – 29, 2018.
WASHINGTON, DC – August 15, 2017 – Independent healthcare accreditor URAC today opens for public comment the proposed performance standards for the organization’s new Genetics Precision Medicine Accreditation program.
Dental plans seeking to widen their provider network while providing an exceptional member experience can differentiate themselves through accreditation. It provides an objective, external review of the quality, security, safety and fairness of their operations and assures providers and members alike that the plan adheres to industry best practices in all areas. But that’s just the beginning.
URAC’s Industry Insight Report Explores How 5 Healthcare Organizations Navigated the Complexities of Becoming Clinically Integrated Networks
Discover how five different healthcare organizations navigated the complexities of becoming clinically integrated networks (CINs) to achieve success in the new value-based healthcare economy, in our Industry Insight Report “Clinically Integrated Networks: A Framework for Clinical and Financial Success.”
WASHINGTON, DC – July 18, 2017 – Independent healthcare accreditor URAC opens for public comment proposed performance measures for these accreditation programs: Health Plan, Pharmacy Quality Management, and Telehealth.
How do you make your best even better? Regardless of the industry or the organization, answering this question is a driving force behind any leadership team’s efforts to continually fulfill its mission, vision and goals.
Apply Patient Outcomes Measures to Telehealth Programs, Avoid Unnecessary Measure Development, URAC Advises
In comments submitted on June 30, 2017 to the National Quality Forum’s draft framework for telehealth measures, URAC expresses its support of the NQF telehealth committee’s report and provides recommendations.
Residents of more than half of the counties in the U.S. have no access to mental health professionals, making telepsychiatry an absolute game changer for improving access and closing disparity gaps.
WASHINGTON, DC – June 27, 2017 – URAC Director of Government Relations Aaron Turner-Phifer discussed key points of the healthcare reform legislation now under consideration in the Senate during a 20-minute appearance on News 4 Your Sunday, which aired June 25 on the Washington, D.C.-based NBC4. Viewers can watch the entire 20-minute interview below.
The U.S. specialty pharmacy industry is growing. Much of that growth can be attributed to healthcare provider-owned pharmacies. This infographic provides a snapshot of some key statistics on the specialty pharmacy industry trend in hospital systems.
CMS continues to ease administrative burdens for physicians as the “slow ramp-up” of the Quality Payment Program continues in 2018, according to the agency’s proposed rule for MACRA’s 2018 Quality Payment Program.
WASHINGTON, DC – June 23, 2017 – How will the role of case managers change as the aging population brings greater demand for post-acute care? How will case management help drive transformative change in healthcare delivery? What progress has been made in identifying quality standards and strategies to support the transformation of case management?
URAC Presents Pharmacy Accreditation Standards Two-Day Workshop Following the 2017 NASP Annual Conference
WASHINGTON, DC – Independent healthcare accreditor URAC today announced a two-day workshop on the Pharmacy Core v3.1, Specialty Pharmacy v3.0 and Mail Service Pharmacy v3.0 accreditation standards, being held at the Washington Marriott Wardman Park on September 21-22, 2017. The workshop will be conducted immediately following the 2017 National Association of Specialty Pharmacy (NASP) Annual Meeting, September 18-20.
URAC tells its story in the “2016 Year in Review” – a visual report that gives a snapshot of accomplishments in 2016, describes our non-profit mission and values, articulates what we do and why we do it, and provides employee stats.
Accountable care may still be a relatively new model in some areas, but the numbers of ACOs are steadily increasing. There were approximately 660 ACOs in the U.S. in 2015. The number increased to 838 last year. Success, however, can be elusive.
The drive toward value-based care is requiring the healthcare industry to make a 180-degree turn from where we were just a few years ago. We’re moving away from a system focused on treating sickness to one that strives for wellness; from encouraging volume to demanding value; from filling beds to penalizing readmissions; and finally, from a system centered on the provider to one that rightfully revolves around the patient.
Why Phoenix Children’s Care Network Became the First URAC-Accredited Clinically Integrated Pediatric Network
When Phoenix Children’s Care Network (PCCN) became the first clinically integrated pediatric network to achieve URAC accreditation in April, it blazed a trail that other children’s hospitals are starting to follow.
WASHINGTON, DC – May 30, 2017 – Independent healthcare accreditor URAC opens the revised Case Management Accreditation Standards for public comment beginning on May 30, 2017, and ending June 23, 2017, at 6 p.m. Eastern Time. Click here to access the proposed Case Management standards and the tool for providing public comment: https://accreditnetadmin.urac.org:443/UracPortal/Comment/Preamble?pcId=9495.
Innovative utilization review strategies are putting a big dent in soaring workers’ compensation drug costs, particularly when it comes to opioids.
On April 19th, President Trump signed into law (S. 544) extending the Veterans Choice Program which allows some veterans to receive healthcare from local doctors and hospitals. The legislation passed with broad bipartisan support – the bill was approved, by voice vote, in both the House and the Senate.
Healthcare organizations increasingly view telehealth technology as a strategic tool in expanding the reach of their services. According to a survey released on April 19 by the tax, audit and advisory firm KPMG, one-third of providers now use video-based virtual care and remote patient monitoring services, while about three-quarters of healthcare organizations currently have virtual care incentives in place.
Advanced telehealth programs have the potential to transform the workers’ compensation industry, providing injured employees with a convenient, personal and effective alternative to on-site medical care while reducing utilization of unnecessary services.
With healthcare costs on the rise, telehealth is increasingly being seen as a way for healthcare organizations to save money. A March 2017 report by The Rural Broadband Association suggests telehealth use holds the potential for robust savings. While the cost savings vary by state, the U.S. national average of hospital cost savings per medical facility is estimated at $20,841. In California, for example, the annual hospital cost savings is estimated at $104,564 per facility.
LAS VEGAS, NV – April 24, 2017 – URAC’s President and CEO Kylanne Green and Director of Pharmacy Heather Bonome have been selected to speak at the 2017 Asembia Specialty Pharmacy Summit at the Wynn & Encore Las Vegas. URAC is the premier accrediting organization in the U.S. pharmacy industry.
URAC White Paper Highlights the Changing Role of Specialty Pharmacy and Its Impact on Patient Outcomes
WASHINGTON, DC – April 19, 2017 –Independent accreditor URAC today released a new Industry Insight Report for specialty pharmacy providers entitled “Competing in the Specialty Pharmacy Market: Key Competencies for Performance in Value-Based Healthcare.” The report examines why specialty pharmacies need to incorporate a sixth right -- the right result -- to the traditional “five rights” of medication administration, to be successful in the value-based healthcare model. The patient-centric care model, when employed by specialty pharmacies, means working with individual patients and their providers to achieve the drug’s intended therapeutic result and prevent a costly hospital stay.
Washington, DC -- In a series of articles with nationally recognized health industry leaders, URAC finds that value-based, coordinated care will continue to be the goal for physicians, pharmacists, case managers and others. URAC, the independent leader in promoting healthcare quality through accreditation, education and measurement, compiled comments from industry leaders over several weeks. The articles appear on the URAC blog.
I once had a local politician tell me that a poll reflects the mood of the particular day it was taken and often ends up wrong in the end. For him, people were fickle and he wouldn’t let one poll dictate his fate.
As the healthcare industry continues its efforts toward improved health outcomes, lower costs, and value-based reimbursement models, case managers have an opportunity to play an even more critical role, said Cheri Lattimer, RN, BSN, executive director of the National Transitions of Care Coalition. While this profession encompasses a number of important responsibilities in healthcare organizations, Lattimer points out three specific areas of growth in 2017 for case managers: patient engagement and education, transition planning, and role development.
Getting accredited or certified, whether it’s for a patient-centered medical home, clinically integrated network, pharmacy services, or healthcare management services, is a major commitment.
As the Department of Veterans Affairs (VA) prepares to award contracts for managing its Community Care Network in four regions nationwide, organizations should keep in mind the importance of delivering sustainable, local healthcare solutions.
The convenience of being able to speak to a physician via live videoconference is changing healthcare, but how do we maintain quality control and keep our personal data safe?
Announcement provides proprietary information to accelerate healthcare transformation
Washington, DC -- Independent accreditor URAC today made public its proprietary standards for the organization’s Patient Centered Medical Home (PCMH) program. The announcement, which provides a complimentary download of the PCMH Certification standards, is part of an effort to help primary care practices nationwide implement best practices for providing value-based, quality medical services.
There’s a changing philosophy in health utilization management today, away from simply thinking of it as a cost-containment approach and more toward using it as a proactive tool to achieve the oft-repeated mantra of the right care for the right patient at the right time. Data and automation are increasingly being used to make that shift possible, while also putting greater power in providers’ hands to make medical decisions.
While the new administration has brought uncertainty to what the Affordable Care Act will look like in the coming year, industry experts believe that the healthcare transformation will continue.
Four experts shared their insights into trends, opportunities and challenges for the coming year for physicians and provider networks.
Health plans are increasingly seeking ways to cement partnerships with the providers in their networks, helping to provide tools that will allow them to survive and thrive in the move toward value-based care. At the top of that list is leveraging the enormous amount of data that payers have available and putting it to use to make it easier for providers to do business with them.
It will be just as much a year of change for the pharmacy market as it will be for physicians and provider networks. Many of the same market pressures on providers are bearing down on pharmacies as well, including the challenges of more collaborative care, squeezed margins and the transformation toward value-based care.
The arrival of a new year and new administration inevitably brings a measure of uncertainty. Within that uncertainty may lie some of the healthcare industry’s greatest challenges for 2017, but it also can yield some of its greatest opportunities. That’s the mindset of case management experts as they reflect on the coming year.
Washington, DC -- Independent accreditor URAC today published its latest industry insight report addressing the present and future of the telehealth industry. The report, Disrupting Healthcare: Risks and Rewards of Telehealth, examines the major factors driving the growth of telehealth in the U.S. healthcare sector, including financial incentives, changing medical philosophies and a growing need to serve patient populations who lack access to care.
It is no secret that the Department of Veterans Affairs (VA) has faced tremendous challenges providing our nation’s veterans with access to the timely, quality care they deserve.
National Quality Forum Selects URAC to Participate in National Quality Partners Leadership Consortium
Washington, DC, – URAC’s Vice President for Quality, Research, and Measurement, Marybeth Farquhar, PhD, MSN, RN, has been selected to represent URAC on the National Quality Partners (NQP) Leadership Consortium in 2017.
Just like the critical handoff of the baton in a relay race, a smooth transition of care from one healthcare provider or setting to the next is key to reaching the finish line of positive health outcomes, lower hospital readmissions and fewer medication errors. In the move toward value-based reimbursement, best practices in transitions of care have never been more important.
“It’s not just looking at the medical aspects of what the patient is dealing with, but those non-clinical issues that so many times impact a transition and can cause avoidable hospital readmissions,” said Cheri Lattimer, executive director of the National Transitions of Care Coalition. “In good care coordination, the team understands their role is not done when the patient walks out their door. The team must put forth the effort to communicate, share and transfer information and make sure the patient and family caregiver are included.”
Patient experience plays a big and increasing role in measures of quality, accounting for eight of CMS’s 34 quality care measures for ACOs, for instance. That’s why many providers and health plans are taking steps to make sure their call centers enhance patients’ satisfaction rather than leave them hanging up in frustration.
“It’s just like with any customer service line, if we have to wait on hold forever, it leaves a bad taste in your mouth,” said Bonnie Zickgraf, integrated services manager for URAC. “Plus, with social media, the bad experiences are 10 times more magnified than the positive ones.”
The American healthcare system is in a state of uncertainty. And it is failing patients.
At least that’s the assessment I’ve frequently come across over the past few weeks. Roiling politics and the resulting policies seem to be the root of this uncertainty. Be it the changes ushered in by the Affordable Care Act (ACA) or the looming changes brought by the election of Donald Trump and a Republican-controlled Congress, it seems that healthcare will be in a state of flux and disarray for the foreseeable future.
By James (Larry) Holly, M.D., CEO, Southeast Texas Medical Associates
Southeast Texas Medical Associates’ (SETMA’s) pilgrimage toward Patient-Centered Medical Home (PCMH) began in 1999 as a result of our study of Peter Senge’s The Fifth Discipline. In that study, we identified ten principles which would guide our development in both our practice and in the electronic medical record (EMR) tool which we would design. (see SETMA: May, 1999 - Four Seminal Events) Ten years into our development, we realized that those ten principles were also the principles of PCMH.
Healthcare ranking systems intended to measure quality of care can garner mixed reviews among providers. While many critics point to flaws in how such systems are structured, organizations like URAC are focusing on approaches to quality measurement that may be more reflective of provider performance.
“Ranking systems are heavily weighted toward process measures,” says Marybeth Farquhar, URAC’s Vice President of Quality, Research and Measurement. “Many of the measures that contribute to a ranking are basically indicating that a task has been completed, rather than looking at patient outcomes that resulted from that task.”
By James (Larry) Holly, M.D., CEO, Southeast Texas Medical Associates
To be successful, the implementation of new policies and initiatives that will produce the future we imagine must be transformative – which comes from within.
Transformation results in change that is not simply reflected in shape, structure, dimension or appearance, but is also part of the nature of the organization being transformed. The process itself creates a dynamic which is generative. It not only changes that which is being transformed but it also creates within the object of transformation the energy, the will and the necessity to sustain and expand that change and improvement. Transformation is not dependent upon external pressure (rules, regulations, requirements) but is sustained by an internal drive which is energized by the evolving nature of the organization.
“Only two things in life are certain – death and taxes.” I had a high school teacher who liked to pull out this famous quote from Benjamin Franklin every time he got an unanswerable question from some wisenheimer.
As I sat last week poring over hundreds of pages of health plan brochures trying to sort out the best option for my family, I’m reminded of this quote and can’t help but wonder if there is a third certainty in life that Mr. Franklin missed – health insurance is about as clear as dishwater.
Hardly a month goes by that we don’t hear about a cyber or ransomware attack on a healthcare provider, manufacturer or health plan. Though major attacks are the ones that make the news, healthcare providers across the country face the risk of an attack of any size.
The Privacy Rights Clearinghouse estimates that more than 900 million records have been breached in the United States since 2005 as a result of nearly 5,200 reported incidents. Of those, about 30 percent—more than 1,500 data breaches—occurred in the healthcare industry.
Uncertainty in the legal and regulatory landscape. Lack of HIPAA enforcement. Little interest in fraud from the OIG. State licensure statutes that were written long before the technology for telehealth existed. Risks to quality healthcare. Plus, the changing expectations from patients as consumers.
The rapidly growing telehealth industry is replete with challenges – and opportunities, which was the focus of a URAC-sponsored webinar, Challenges and Outlook for Telehealth in the Changing Healthcare Economy, on October 26, 2016. URAC Vice President Deborah Smith moderated the discussion with Adam Romney, partner at Davis Wright Tremaine, and Robert Bernstein, MD, vice president for clinical affairs, Carena.
They say that “states are the laboratories of democracy.” In no place is this more evident than the state of Vermont’s efforts to radically change their healthcare delivery system.On October 26, CMS and Vermont’s Green Mountain Care Board (GMCB) jointly announced the Vermont All-Payer Accountable Care Organization (ACO) Model. This new, first of its kind initiative is aimed at accelerating healthcare delivery reform for the entire state and its population by establishing a statewide ACO that is responsible for the health outcomes of its entire population.
If physicians don’t understand MACRA – or think they don’t need to understand MACRA – how will ACOs get physician practices to align with the requirements of the Patient-Centered Medical Home (PCMH) model?The transition from traditional fee-for-service to value-based payment models, and the focus on patient-centered medical care and population health, has driven the proliferation of Accountable Care Organizations (ACOs).
While many interested parties are watching how the legal action plays out in Texas with Teladoc’s federal antitrust lawsuit against the Texas Medical Board (TMB), there’s another way to address the issues other than regulations.
Recently, a number of parties filed friend-of-the-court briefs with the Fifth Circuit supporting Teladoc’s case, including the Justice Department and the FTC. And although the TMB has withdrawn its appeal, it plans to continue to fight Teladoc in the lower court.
The challenges for telehealth are significant, but the potential benefits are immense. The healthcare industry must address and overcome the issues – as we cannot afford to walk away from the benefits.
“There are known and agreed-upon major and chronic health problems in this country,” said Kylanne Green, President and CEO of URAC. “Many Americans live with diabetes, obesity or multiple life-threatening conditions. Telehealth has demonstrated effectiveness against those health issues and many others.”
With the final MACRA rule released on Oct. 14, the industry is now getting the chance to dig into all of the details of this 2,300-page document, especially the act’s Quality Payment Program, which replaces the Sustainable Growth Rate formula with two tracks of reimbursement—the Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS).
“Folks are now in the process of getting their heads around what’s in the final rule and determining what they have to do to respond in 2017,” said Aaron Turner-Phifer, URAC’s director of government relations and policy. “The most important thing right now is for practices and clinicians to be engaging with their medical societies and educating themselves on the best path forward.”
Watch this video for quick overview about MACRA (Medicare Access and CHIP Reauthorization Act of 2015), and what you need to do to succeed in the new healthcare economy.
With accountability for patient outcomes increasingly spread throughout the continuum of care, pharmacies play a larger role than ever in delivering quality care.Pharmacy is increasingly involved in patient management, helping with coordination of care, providing education to patients—particularly those with chronic conditions—and acting as a clinical advisor to other providers.
A foundational principle of all healthcare providers is to keep the focus on patients and their specific needs. It’s also the philosophy at the heart of the Patient-Centered Medical Home concept.This concept and process can serve as invaluable guidance for transforming your practice, especially in the shift toward value-based reimbursement
For some physician practices, the demands of the Affordable Care Act have brought with them administrative and technical burdens, and an increasing number of providers are responding to that trend by consolidating with fellow practitioners.
Consumer advocates warn of the possibility of increased costs because of less competition due to consolidation, while others say it can advance the type of collaborative care that will improve patient outcomes.
Spending on telehealth services in the United States is expected to increase nearly tenfold in just five years.
According to projections from IHS Technology, telehealth spending per year in the United States will rise from just $240 million in 2014 to $2.2 billion in 2018. It is predicted that there will be 7 million telehealth encounters of all types by 2018.
The road to accountable care and value-based payment is a long one, chock full of obstacles along the way. But there are key checkpoints on the journey.
URAC’s Clinical Integration Accreditation standards address how to best position your organization to achieve success in a value-based economy, including governance, alignment, care coordination, and integrated infrastructure. Here are the top four things you need to know for clinical integration success:
We all know healthcare is changing, and the driver for much of this change is the government. MACRA (Medicare Access and CHIP Reauthorization Act of 2015), the latest sweeping healthcare reform law from Congress, is being massaged by CMS, and while most believe it is the physician at the tip of the MACRA spear, it will have a profound impact on pharmacists, too.
MACRA will fundamentally change how providers are paid. It’s about time. Fee-for-service, the “do more, get more” reward system that has sent us into an economic tailspin in healthcare may finally become a thing of the past. Under value-based payment, the foundation of the reward system will be quality. This change in philosophy, from volume to value, and the change in economics, requires a shift in the existing relationships among stakeholders.
There is sweeping new federal regulation that will impact the future role of managed care nurses and physicians in the most challenging of ways. This new law is referred to as “MACRA.”
MACRA will overwhelmingly affect pre-authorizations, clinical coding review, claim reimbursements, policy development, performance measures and coordination of care, defining new roles for Medicare providers and managed care professionals in the United States.
URAC launches the first independent, third-party telehealth accreditation program.
Telehealth is a powerful tool that can help improve health outcomes and lower healthcare costs. By creating efficiencies and extending the reach of existing providers, it has the ability to ameliorate healthcare workforce issues and can reduce health disparities for aging and underserved populations by overcoming access barriers and reducing both costs and burdens for patients around the globe.
Commenting on the imminent release of a final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt anticipated this new healthcare policy will give providers a “proliferation of opportunities.”
The final MACRA rule is expected to be released by CMS on or about November 1. It will implement the Quality Payment Program (QPP) that will replace the Sustainable Growth Rate governing Medicare reimbursements for providers treating Medicare beneficiaries. The QPP promotes value-based, coordinated care over the traditional fee-for-service method. It requires that participating practices cite progress through measures of performance.
With nearly two-thirds of Americans under the age of 65 covered by private insurance, no innovation in health care delivery can succeed without the support of health plans and employers. That’s why it’s not enough for the Centers for Medicare & Medicaid Services (CMS) to get behind the value-based reimbursement model; private payers need to get on board as well.
“To effect change in health care, you can’t do anything without employers and commercial insurers,” said Aaron Turner-Phifer, URAC’s director of government relations. “To have an actual long-term, coherent, seamless health care strategy, you need commercial insurers, private insurers and private employers working hand-in-hand with the things government is trying to do.”
While most healthcare providers agree the move toward fee-for-value is a positive advance for the healthcare industry, this shift away from fee-for-service isn’t coming without its challenges.
That’s especially true for providers who serve patients in rural and underserved areas and now must implement changes dictated by the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA.