The Role of PCMH Under MACRA

October 8, 2016 · Amy Maciejowski

MACRA is monumental. Congress is changing how the government pays providers. The impact is “pretty herculean” according to Adele Allison, the Director of Provider Innovation Strategies at DST Health Solutions. Allison delivered one of the first presentations on the first day of PCMH Congress: “The Role of PCMH Under MACRA.”

The room was packed: a testament to the attention that MACRA attracts all over the country. And rigadele-allisonhtfully so. The “herculean impact” of MACRA, as Allison aptly puts it, is certainly not a myth. In fact, it will be effective in the next few months. In order to be paid in 2019, practices will need to start reporting data at the beginning of 2017.

Quality now intersects with payment.

Many in the room at PCMH Congress are familiar with measuring performance. But now, practices will see their performance measurement directly affect revenue.

MACRA is not an “in the moment” legislation. It has had bipartisan support from the start and throughout every presentation on MACRA, stakeholders and organizations agree: it is here to stay. No matter what the new administration brings.

“CMS is a payer- so what do you think Cigna, Blue Cross Blue Shield and United will want? The same thing,” said Allison. “(MACRA) will permeate and start immense change in the way you are being paid.”

PCMH Trifecta

There is a silver lining in all this. As Allison mentioned “what better positioning can a practice have than to be a PCMH?”

NCQA PCMH and PCSP are specifically called out in the proposed rule. For the Clinical Practice Improvement Activity (CPIA) category, PCMH and PCSP Recognized practices receive 100 % credit for that category. Then, Allison states, recognized practices will likely get credit for Advancing Care Information (previously referred to as “meaningful use”) because of their experience with the NCQA standards and elements. CPIA and Advancing Care Information come to about 40% of MIPS categories.

As practices, health systems and consultants learn more about MACRA this weekend and about the value of a PCMH transformation under MACRA, the “herculean” impact will hopefully seem a bit more manageable.

A full recording of Adele Allison’s presentation on the “Role of PCMH Under MACRA” will be made available at the end of the PCMH Congress.

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