Creating a high-performance monthly MACRA program

For standalone groups of 100 or fewer providers, it should be enough to run reports from your EHR monthly, post them to a standalone MACRA database for performance analysis, and discuss shortfalls against targets.  But for complex multi-TIN organizations, including ACOs, Monthly MACRA needs a bit more.  Like any other sophisticated corporate undertaking worth millions of dollars, it makes sense to have a plan that incorporates a schedule, identifies reporting tools, commits resources, and sets expectations around responsibilities.  

Setting the Vision

 Our program starts with a Blueprint document that communicates an organizational vision for why MACRA is important, what activities drive success at what points in the year, and what resources exist. Every stakeholder receives a copy of the Blueprint.  

Tools and Team

Beyond the Blueprint, our Program for complex organizations runs on a series of monthly meetings, supported with a Sophisticated MACRA database that crosses all TINS, standardizes content from multiple EHRs, and converts scores into financial results meaningful to executive staff. The quarterback for the program is our MACRA Concierge, who conducts all meetings, educates provider groups, analyzes data, and recommends mitigations.  

Provider Contracting

Because the impact of today's MACRA activity does not translate into revenue (or penalty) until two years into the future, provider / TIN contracts may need to set expectations for current year behavior,  and identify consequences.  The contractual behaviors include participation in mandatory collaborative sessions coordinated by the MACRA Concierge, and the MACRA database tracks these participations, in addition to performance against PI and CQM metrics.  

Meeting Cadence

 Monthly MACRA implies a set of regular monthly meetings, supported by specific analyses. Every month involves aggregating data from all TINs into the MACRA database, where the Concierge identifies shortfalls and mitigations.  At a single general meeting for all TINs, we share overall scores and financial results.  For ACO's the TIN content is converted into ACO-level MIPS score.  The general meeting is also the educational forum for month-specific activity (if any) based on the CMS calendar of events.  

For TINs falling below performance thresholds, and in need of remediations, we conduct 30-minute, one-on-one meetings to provide support, answer questions, and document action items around provider-level and metric-level shortfalls.  

Monthly MACRA Newsletter

Our MACRA database is the source for newsletter content customized to each TIN.  The newsletter includes sections that celebrate top performers, and summarizes CMS content relevant to each month (where appropriate) at a level of detail relevant to TIN management.  

We also identify providers performing below target, quantifying the financial impact on overall MACRA revenues of sub-optimal performance.  

Finally, the newsletter displays the TINs MACRA scores, compared against the organization-level aggregate, providing organizational context. 

Bottom Line

A high-performance Monthly MACRA program requires more than simply running reports from an EHR.  Complex organizations and ACOs need clear expectations, communication channels, and adequate resources.  With the right staffing, education and enabling tools, the financial benefits of MACRA can easily exceed shared savings benefits created by successful ACOs.  

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MACRA Monitor is an subscription-based product from C3 Partners that combines a MACRA database with dedicated Concierge service for ACOs and other complex organizations