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Coordination and communication central to value-based care

Michael Macaluso, Vice President of Product Management, Ingenious Med

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is coming into play on January 1, 2017, and while CMS has recently added options for providers to ease into compliance, the overall mechanism to impose penalties (upwards of nine percent) for under-performing healthcare systems still remains a core part of the program. The goal of this new legislation is simple: rewarding quality care delivered at lower costs. MACRA continues a strong legislative push to move the U.S. healthcare system from a volume-based to a value-based model.

As pressure increases to “do more with less,” we’re seeing health systems start to hone in on the challenges they face as part of this transition to value-based care. Becker’s Hospital Review recently published an article that showed care coordination is the biggest issue for managing health populations – more than a quarter of healthcare organizations surveyed by HIMSS named this their top challenge. The problem for many is highly fragmented, inconsistent systems that are spread across numerous sites and providers. This leads to major breakdowns in care communication and coordination.

If providers are going to improve patient outcomes, patient satisfaction and health populations AND reduce costs, then they must improve communication and coordination. There are only so many variables. These particular ones are key to moving the patient through the continuum of care as smoothly as possible with the best outcomes and at the lowest possible cost.

To achieve this, healthcare providers are seeking IT solutions that defragment and streamline care team communication so that the right information gets to the right people at the right time. Such solutions should encourage teamwork, clarify roles, establish accountability, smooth transitions from one setting to the next, collect meaningful data, and offer consistent monitoring of the patient throughout the care journey.

EMRs are not designed to do this and they struggle to support these workflows. Patient registration systems and billing systems also are not positioned well to support these workflows. My focus has been on care coordination and communication arena for some time now. Anticipating the move toward value-based incentives, my team and I have tried to stay ahead of requirements to improve financial and clinical outcomes for healthcare organizations. The solution we’ve produced combines robust charge capture capabilities with care coordination, documentation and performance analytics.

With MACRA coming online and a growing need for more care coordination efforts, it’s imperative to focus on expanding care coordination capabilities even further. The essential tools that will help healthcare organizations achieve MACRA excellence should include communication capabilities, group communication, high-risk and discharge delay flagging, care team management, and real-time electronic cross-cover notes for rounding and patient hand-offs. Such technologies will eliminate communication fragmentation that stands in the way of sprinting toward the volume-to-value finish line.

In considering the needs of the industry, my team and I have firmly focused on key areas of development, largely moving toward the goal of interconnecting providers, care teams and organizations. We believe that MACRA standards can be achieved by improving transitions from the Emergency Department to the hospital and then to post-acute facilities. This is what MACRA is about, and it is the solution we believe will be best for meeting the rigorous, but achievable, demands.

Ingenious Med started “The Right Side of Healthcare” Tour earlier this year to help deliver this message out to the industry. But this isn’t something that we’ve just started doing because it’s the latest buzzword to hit the healthcare industry. We’ve been working on this for years now based on input from our clients and from our own founder, Dr. Steve Liu, whose continued clinical expertise is instrumental in the design of our application.

Federal legislation and patient demands are driving healthcare to change – to shift from volume to value. In the end, this will be a move for the better, but it won’t be an easy transition. The timeframes for transitioning will get tighter and penalties higher. It’s a fact that we cannot deny. Sometimes the challenges overshadow the results for those facing these hurdles on a daily basis. That’s why it’s important to find true partners in your IT vendors, ones who look forward and keep an eye on the horizon so you can focus on providing the best care possible now and moving forward.


For more on MACRA, see our recent webinar.