Adapting to Payment Reform: Advice From McKesson's Suzanne Travis

As the healthcare industry continues its transition towards alternative payment models (APMs), some providers might feel apprehensive about keeping up with new requirements like those in the Medicare Access and CHIP Reauthorization Act (MACRA) final rule. However, these providers can use healthcare information technology (IT), data analysis tools, and other resources to adapt to these changes, according to Suzanne Travis, vice president of regulatory strategy at McKesson.

At McKesson, Travis keeps "an eye on the trends of what CMS is doing with the changes in Medicare” and “understand[s] the implications of that for our customers so that we can support them as best we can.”

A major example of CMS transitioning away from a fee-for-service environment and toward alternative payment models (APMs) is the recently released MACRA final rule. Travis praised CMS for “listening to providers and taking their feedback on the proposed rule.” In particular, she said the “pick your pace” option for the first year was a “positive step that will give providers time to understand the program without the threat of financial penalties.” The “pick your pace” option, which allows providers to avoid penalties if they report just 1 quality measure in 2017 but provides additional bonuses for more reporting, was a successful way for CMS to “navigate all the feedback that they got on the timing being too aggressive, compared to their need to move forward with getting the program in place,” according to Travis.

Travis also cited the Advanced APM Comprehensive Primary Care Plus program, which is restricted to practices with 50 clinicians or less, as an example of CMS “clearly wanting that program to be a way for small practices to make it to the Advanced APM track.” She also recommended that small practices take advantage of the resources CMS has offered, because there is “funding in the law for setting up programs to help small and rural practices to succeed under the program.”

Practices that had previously been participating in the Physician Quality Reporting System (PQRS) and meaningful use can continue on with the work they had been doing and they should be “in pretty good shape in 2017” under the new Merit-based Incentive Payment System (MIPS). Travis advised providers who were not participating in those reporting systems to “pick some quality measures or pick the Advancing Care Information category, and start working on that while developing a plan on how you’ll get through all of the categories by 2019.” Finally, she encouraged eligible practices to “look into becoming a patient-centered medical home or an equivalent specialty practice, because there are advantages to being a patient-centered medical home both in the MIPS program as well as potentially in the Advanced APM program.”

There are also a few ways that health IT tools can help practitioners keep up with new APM requirements, said Travis, who has more than 20 years of experience in healthcare IT strategy. First, these tools provide performance feedback so providers know how they are performing and where to focus improvement efforts.

“Healthcare IT can give those performance metrics on a regular basis so that [providers] know that the work that they’re doing is progressing them towards their goals," she said.

Health IT can also help practices improve by providing internal information so they can analyze performance on quality measures or variations in costs or outcomes among providers. However, they can also look externally and see how the practice compares on cost and quality with regional or national benchmarks

“Finally, I think healthcare IT can be used within performance improvements themselves,” Travis said. Two examples she gave were decision support tools embedded into a clinician’s workflow, or using IT to implement evidence-based protocols.

However, Travis emphasized that health IT is only 1 part of the solution. “Consultants always say it’s people, process, and technology that must work together to make positive change,” she said. “So I think folks also need to keep in mind that technology is not a silver bullet, and they need to really be working on this as a holistic approach.”

She mentioned that analyzing costs can help practices to both improve outcomes and reduce costs. “Understanding their costs can help them identify areas where there’s a lot of variation in costs,” said Travis, so they are able to “see how they can reduce it and have more predictable costs.”

Travis also said that population data analysis can help providers learn “where they need to focus their efforts and create programs that will improve their patient population’s health” and gave the example of an accountable care organization that analyzed data on their self-insured employees and found a high prevalence of asthma. “You may not know what you’re going to get out of the data when you run the report, but once you run the report you can find trends and information that wasn’t obvious without looking at the data,” she said.

Overall, Travis felt that the changes in the industry are very positive. “I think that it’ll be really interesting the next several years as providers and health IT vendors can work together to find the best ways to meet the objective of improving outcomes while maintaining or decreasing costs,” she said, adding that she was “looking forward to being part of helping the industry through this change.”