PREPARING FOR MACRA
The Medicare Access and CHIP Reauthorization Act (MACRA), is being brought in to replace the Sustainable Growth Rate formula and requires clinicians to submit outcomes data in order to qualify for reimbursement.
Under the new rules, quality measures will no longer be a pass or fail metric, but will be used to directly adjust reimbursement sums on a sliding scale. Outcomes will also be published on the Hospital Compare website, with the aim of making it easier for patients to evaluate physicians.
So what implications does this have for the way you run your business?
Providers need to focus on improving outcome quality, but also need a better way of selecting which outcomes measures to track and submit in the first place.
Lumeon’s Care Pathway Manager platform makes coordinating care and tracking incremental outcomes easier. Providers can create automated digital workflows (or “pathways” as we call them) that capture data from patients and send them guidance and resources. They can also automatically allocate tasks, or create alerts for care teams across the care continuum, based on the patient’s real-time risk status.
Introducing automation for things like digital education programs and early warning risk alerts can help improve outcome quality, patient satisfaction, and efficiency. Meanwhile, our advanced analytics engine can provide a comprehensive view of the strengths and weaknesses of your network.
Enhanced outcome capture and easier reporting
Care Pathway Manager makes it easier to see what’s going on with patients by enabling you to automatically send them e-forms at regular points in the pathway, as well as integrating data from remote health monitoring devices. Provide physicians with faster reporting tools and standardize data capture across multiple sites.
Automated risk profiling for early intervention
Automatically send e-questionnaires to patients and can track and calculate risk scores throughout the patient journey. Care Pathway Manager can present key information on color-coded dashboards, or by sending alerts to physicians. This helps identify ‘at-risk’ patients so you can intervene earlier to keep them on track.
Single real-time view of the patient journey across the care continuum
Our approach enables providers to assign every patient to a longitudinal pathway, integrating data from third-party software (claims software, EHRs and pathology systems etc.). We provide a central system which can distribute information, allocate tasks to the right people and coordinate care across multiple teams.
Lumeon Analytics enables providers to run consolidated reports across all patients. Compare financial and clinical metrics to obtain visibility into your best performing pathways and physicians, and discover which engagement strategies produce the best results.
Better follow-up processes for improved outcomes
Establishing consistent follow-up with patients enhances your ability to identify potential problems. Care Pathway Manager allows you to create workflows that blend regular follow-up calls or virtual care events with automated patient guidance.
Better patient experience and compliance
From pre-procedure prep to post-surgical physical therapy, Care Pathway Manager can dynamically personalize resources based on each patient’s profile. This means they receive relevant and timely assistance via app email or portal. It can also chase them if they have not submitted data or completed activities.