Becker's Hospital Review

35 up choosing them, and it will be hard to score well because the bar will be set so high," says Mr. Johnson. Health plans should assess STARs and other quality program market place trends to consider regional impacts and adjustments. Where vol- ume is exceeding value, plans should be prepared to address potential decreases in Medicare Advantage county benchmark rates. ese may also be regions where providers are more likely to consider shiing costs to commercial contracts or to Medicare Advantage from Medi- care fee-for-service. 2. Consider market peers. Mr. Dolstad also cautions both payers and providers to consider how geography can impact success in either track of the program because quality and cost vary regionally. e big- gest blind spot in MIPS, especially in the early years of the program, is gauging how well other practices are doing. And in the Advanced APM track, regional variance in spending drives how CMS sets expenditure baselines for ACO models, Mr. Johnson adds. "You need to look at marketwide dynamics in addition to your own performance," he says. 3. Increased hospital consolidation and employment. As physicians go through the MACRA impacts and planning process, they will be looking to hospitals and health systems for a leg up. Larger provider entities tend to have more data and more practice with that data, which is attractive to smaller physician groups with less reporting experience. "[Hospitals] are increasingly being put on the spot by em- ployed and affiliated physicians asking, 'What can you do to help me here? Can you get me out of MIPS to bundles or a risk-bearing ACO model?'" While this puts the onus on hospitals to provide resources for physi- cians, it also puts them in the driver's seat for consolidation. "Health systems can help quantify some of the opportunity and risk physicians might face, which is why there is going to be some implicit pressure for greater M&A activity in these markets," Mr. Johnson says. Hospitals also control a significant portion of the healthcare dollar through acute and post-acute care, which will play a large role in suc- cess under value-based care programs. "Hospitals have the ability to help aggregate physicians, provide that capital and that risk shelter area to help physicians move along and be able to manage populations and manage risk, which is required under both the MIPS and Advanced APM tracks," Mr. Hazelrigs says. 4. Plan for MACRA's affect on commercial business. Phy- sicians trying to avoid MIPS reporting may also try to refocus their patient base in Medicare Advantage — a trend payers need to be aware of and prepared for, Mr. Dolstad says. However, beyond the initial shi to Medicare Advantage, payers should tune in and consider how MACRA will shape future commercial business. "As we think about Medicare and what it's done historically — DRGs and risk adjustment — ultimately all of those concepts made their way into commercial plans and Medicaid," Mr. Dolstad says. "As a result of that, we think it's likely MACRA has the potential to have that same cascading impact into commercial business." In particular, Mr. Dolstad believes MACRA, "ere is that natural fric- tion right now. is could bring the wheels to a halt, or be the lubricant that streamlines everything," he says. Conclusion MACRA and QPP will continue to shift and evolve as feedback is received, but regardless of the current policy or pace of change, MA- CRA's objectives remain clear and consistent. And while there is no one surefire way to win or lose under MACRA, Optum's experts advise payers and providers to simply understand the impacts and stay ahead of the changes. "Understand where you are to- day based on data driven analyses, not assumptions. Understand what your options are and the resulting implications of chang- es, including partnering with other physicians, health systems or gaining alignment between providers and payers to understand how you can be successful," Mr. Hazelrigs says. n 3 RD ANNUAL HEALTH IT + REVENUE CYCLE CONFERENCE September 21-23, 2017 | Hyatt Regency | Chicago, Illinois 150 Speakers from Hospitals and Health Systems – 255 Speakers Total THE BRIGHTEST CIOS, HEALTH IT AND REVENUE CYCLE EXPERTS IN HEALTHCARE REGISTER HERE www.beckershospitalreview.com/health-it-revenue-cycle-conference/ Registration@BeckersHealthcare.com OR 800.417.2035. KEYNOTES BY George W. Bush, 43rd President of the United States of America Sugar Ray Leonard, Boxing Legend, Successful Entrepreneur and Author, The Big Fight: My Life In and Out of the Ring "[Hospitals] are increasingly being put on the spot by employed and affiliated physicians asking, 'What can you do to help me here? Can you get me out of MIPS to bundles or a risk-bearing ACO model?'" — Erik Johnson, Vice President, Value-based Care, Optum

• Cover