MACRAnomics: Patient-Level Economics and Strategic Implications for Providers

MACRA offers provider organizations strategic opportunities to think differently about their business models and pursue sustainable growth and margin levels. With increased accountability stemming from MACRA and related APMs, patient economics has come at the forefront of long-term strategy development. The long-term strategy is to improve patient economics through investments in analytics, consumer relationship management, sales and marketing strategies, network development and wellness and care coordination initiatives while also not overlooking the impact of change management on provider behavior.

MACRA challenges historical models and standards, creating opportunity for providers to succeed:

1. MACRA is significant and transformative. Risk is a matter of when, not if, and providers now face a critical decision point.
2. MACRA serves as a catalyst and establishes principles that will drive providers to establish a Senior Market Strategy and harmonize this strategy across payers.
3. Execution on strategy requires an understanding of the new patient economics both currently and in the longer term.

Success in this new risk environment will require providers to determine the optimal portfolio strategy by addressing the following strategic questions:

1. What are the characteristics of patients that will drive profitability?
2. Based on these characteristics, how can we engage these patient cohorts meaningfully in a productive APM?
3. What is the current efficacy of our existing condition management capabilities?
4. How do I change the patient engagement and health management model to improve margins?
5. What are competitors offering in the market? Would these offerings be attractive to the patients we are trying to engage? How can we create differentiation for our clinical offerings?

Emerging organizational business models that blend payer-provider capabilities will be best positioned to deliver on patient lifetime value strategies. Read more to view HealthScape’s recommendations on adopting new capabilities and positioning your provider organization for success in the new MACRA environment.

CLICK HERE TO READ THE FULL WHITEPAPER

HEALTHSCAPE CAN HELP.

For more insight on leveraging MACRA to pursue long-term strategic solutions and understand the impact of it on population health economics, contact us today.