I was fortunate this spring to be able to meet with several lawmakers in Washington D.C. and St. Paul about our work in health care transparency and measurement. New legislation passed in April and May that will have significant ramifications for Medicare-based payment and the Minnesota Department of Health’s quality incentive payment system.
The legislation creates exciting new opportunities for MN Community Measurement and our community, but also poses new challenges as we focus on maintaining alignment, reducing provider burden and advocating for high-value measurement.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which was signed into law in mid-April, continued the Centers for Medicare and Medicaid Services’ (CMS) focus on payment reform and transparency. CMS is rapidly moving forward with value-based provider payments that are tied to cost and quality rather than volume. They are focused on measure development in key areas including patient-reported outcomes, care coordination, utilization and patient experience. And, finally, they want to increase the availability and use of Medicare data for quality improvement.
Minnesota and MNCM are well positioned to benefit from these changes, particularly around value-based payment. Our community has developed many high-value measures and has experience getting them adopted for use in CMS programs. This local and national alignment helps reduce data collection and reporting burden for medical groups. Our community is also proficient in developing measures in many of the areas where CMS plans to focus, particularly patient-reported outcomes and utilization.
MACRA also creates a role for regional data intermediaries to support medical groups in the transition to value-based payment systems. In doing so, CMS has accepted that we need regional control over data collection and reporting – a significant advantage for Minnesota as a national leader in health care measurement. Additionally, the legislation identifies regional health collaborative organizations – like MNCM – as appropriate entities to play this role.
Finally, MACRA expands the use of Medicare and Medicaid data for quality improvement purposes. As one of only 13 “Qualified Entities” in the nation, MNCM will be able to evaluate and share this information to the benefit our community.
We see several critical roles for MNCM as this new federal legislation is implemented over the next 18 months.
- Advise CMS on the importance of using high-value measures in its value-based payment systems, as well as aligning with local and state programs to reduce provider burden.
- Encourage CMS to adopt, in particular, measures developed in Minnesota to further reduce burden on providers in our community.
- Explore how the data collection and reporting systems that our community already uses could serve an intermediary role with CMS.
- Evaluate funding opportunities for future measure development that is meaningful and valuable to our community.
Perhaps the largest challenge facing these efforts is their rapid pace; the law requires many of the changes be fully implemented by November 2016. The remainder of 2015 will see a flurry of new guidance and regulations about how CMS plans to implement the programs and those details will be critical to our community.
Just before the end of Minnesota’s legislative session in May, the Health and Human Services bill passed with a provision that requires the Department of Health (MDH) to incorporate patient race, Hispanic ethnicity, preferred language and country of origin (REL) as it evaluates provider quality in the Statewide Quality and Reporting Measurement System (SQRMS). This includes taking these patient characteristics into account when risk adjusting results for the state’s quality incentive payment system (QIPS). Additionally, it requires MDH, as well as contracted private entities working on its behalf, to consult with communities impacted by health disparities as part of these efforts.
These new approaches must be in place by July 1, 2016. While this is a relatively short timeframe, MNCM is well positioned to support these efforts as they align closely with work we’ve spearheaded for the past seven years. Our existing relationships with providers on REL data collection, validation, reporting, risk adjustment and segmentation can be leveraged to quickly further the state’s priorities in this area.
MNCM began collecting REL data from medical groups in 2009. Last year, over 85 percent of providers submitting clinical data to MNCM (in Minnesota and bordering states) reported REL data to MNCM; furthermore, more than 70 percent did so using collection and reporting best practices. Earlier this year, MNCM published our first Health Equity of Care Report with five measures stratified by race, Hispanic ethnicity, preferred language and country of origin at statewide and regional levels.
Additionally, MNCM convened diverse stakeholders over the past two years to develop and do initial implementation of risk adjustment using an actual-to-expected methodology, which is noted as an acceptable approach in the legislation.
To that end, we look forward to continuing our work with MDH on our shared goal of eliminating health care disparities in Minnesota.