Mea­sur­ing health­care per­for­mance is their busi­ness, and busi­ness is good

Modern Healthcare - - NEWS - By El­iz­a­beth Whit­man

“Value is the new econ­omy, and mea­sure­ment is go­ing to be the new cur­rency.” CRAIG MCKASSON Chief fi­nan­cial of­fi­cer Premier

To un­der­stand how Medi­care will pay them in the com­ing years, physi­cians have to di­gest new reg­u­la­tions that lay out the de­tails of met­rics they’ll have to re­port on and data they’ll have to an­a­lyze. Doc­tors’ re­sponses will af­fect their in­come start­ing two years from now.

Or they can pay some­one else to sort it out.

A rush of com­pa­nies are sell­ing ser­vices they say will help providers suc­ceed un­der Medi­care’s new physi­cian pay­ment frame­work and other pro­grams in an ever-ex­pand­ing sta­ble of pay­ment re­form ini­tia­tives.

“Value is the new econ­omy, and mea­sure­ment is go­ing to be the new cur­rency,” said Craig McKasson, chief fi­nan­cial of­fi­cer of Premier, a Char­lotte, N.C.-based com­pany that’s ag­gres­sively grow­ing its di­vi­sion ded­i­cated to health­care per­for­mance-im­prove­ment tech­nol­ogy and ser­vices.

On Oct. 14, the CMS is­sued its fi­nal rule im­ple­ment­ing the Medi­care Ac­cess and CHIP Reau­tho­riza­tion Act, or MACRA, which made sig­nif­i­cant changes to the draft rule. The law was con­ceived to coax the en­tire in­dus­try to­ward value-based care, and it’s ac­cel­er­at­ing the de­mand for third­party ex­perts whose ser­vices en­com­pass ev­ery­thing from sim­ply cap­tur­ing in­for­ma­tion to an­a­lyz­ing it for per­for­mance im­prove­ment.

Some of these com­pa­nies are rel­a­tively new. They were born as the 2010 Af­ford­able Care Act pro­duced a spray of new mod­els ex­per­i­ment­ing with ways to tie health­care re­im­burse­ment to qual­ity and ef­fi­ciency. Oth­ers have been in the per­for­mance ser­vices seg­ment for years but are en­joy­ing a boom in busi­ness, thanks to the ex­pan­sion of value-based pay­ment schemes that de­pend heav­ily on the com­plex and of­ten bur- den­some gath­er­ing, sub­mis­sion and anal­y­sis of data in or­der to as­sess qual­ity and costs of care.

Premier’s per­for­mance ser­vices seg­ment saw rev­enue growth of 19% in the fourth quar­ter of fis­cal 2016 com­pared with the pre­vi­ous year. The com­pany said it ex­pected sales to in­crease in the per­for­mance ser­vices seg­ment in fis­cal 2017.

Premier’s ser­vices in­clude clin­i­cal in­te­gra­tion and other pop­u­la­tion health needs, plus anal­y­sis of pay­ment penal­ties un­der Medi­care’s value-based pur­chas­ing pro­gram. The com­pany aims to al­le­vi­ate the ad­min­is­tra­tive bur­den of re­port­ing and max­i­mize per­for­mance.

Readi­ness among health­care providers for MACRA and other pro­grams varies widely. Larger or­ga­ni­za­tions with deeper pock­ets tend to have more ad­vanced tech­nol­ogy, so they’re in a bet­ter po­si­tion to cap­ture, sub­mit and an­a­lyze in­for­ma­tion, said Austin Weaver, se­nior di­rec­tor for con­sult­ing at the Ad­vi­sory Board Co.

But even the in-house abil­i­ties of large health sys­tems have gaps. “They might not have a ro­bust tool like a qual­i­fied clin­i­cal data reg­istry that can in­gest and or­ga­nize in­for­ma­tion,” Weaver said. Oth­ers are op­er­at­ing on a time lag, he said. And with leg­is­la­tion and rules fre­quently changed and up­dated—the fi­nal MACRA rule is proof of that— providers also rely on out­side sources to track cru­cial de­vel­op­ments.

“This is all we do. This is all we think about,” said Dave Terry, the founder of Arch­way, a com­pany that works with providers to im­ple­ment and man­age bun­dled-pay­ment ini­tia­tives. It con­ducts data an­a­lyt­ics and has soft­ware to help providers track pa­tients through­out an episode of care. “We see a lot of fear and trep­i­da­tion among the provider com­mu­nity about pay­ment re­form and what it’ll mean for their busi­nesses and prac­tices and health sys­tems,” he added.

Arch­way has been in­volved in help­ing providers im­ple­ment the govern­ment’s bun­dled-pay­ment ini­tia­tives since the com­pany’s launch in 2014. It is also start­ing to re­ceive more in­ter­est from com­mer­cial health plans and self-in­sured em­ploy­ers, Terry said. And com­pe­ti­tion is grow­ing along with de­mand, he added. “It’s ob­vi­ously be­com­ing a more crowded space.” The per­for­mance ser­vices sec­tor is also be­com­ing in­creas­ingly di­verse. Arch­way, for ex­am­ple, fo­cuses solely on bun­dled pay­ments. San Fran­cis­cobased startup Able Health helps physi­cian or­ga­ni­za­tions nav­i­gate a va­ri­ety of value-based mod­els with pro­pri­etary soft­ware that man­ages all of them in one place.

That soft­ware trans­lates raw pa­tient data into the proper for­mats for re­port­ing, said Steve Daniels, Able Health’s pres­i­dent and co-founder. “At the end of the year, re­port­ing be­comes much less stress­ful,” he said. Mean­while, the soft­ware can also mon­i­tor per­for­mance and pro­vide feed­back in real time.

“If providers want mea­sures that are able to rep­re­sent the care that they’re giv­ing, then those mea­sures have to be com­plex,” said Emily Rich­mond, Able Health’s vice pres­i­dent of qual­ity and per­for­mance im­prove­ment. “And if those mea­sures are com­plex, providers have to un­der­stand that they’re go­ing to need tech­nol­ogy.”

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