Changes in 2017: PODS

Getting past the fact that Congress has vowed to make significant changes to Obamacare, transitions in healthcare in 2017 are already having an impact on long-term strategic decisions.

We need to accept that Medicare Access & CHIP Reauthorization Act (MACRA) is going to happen in ways that redefine the parameters of the Medicare Quality Payment Program, i.e., the long-planned move to value-based performance. MACRA reporting requirements began on January 1st, so the program is operational and the option to do nothing has passed.

The end result of this development is the reality of medical delivery accepting the advent of “risk reward”. It is now time to understand both the upside payment gains and downside penalty impacts. The Management Service Organization (MSO) serving Physician Direct Access (PDA/IPA) anticipates this change, not in a pro or con manner, but as a reality-based opportunity.

Our management has worked in this environment of performance “wins” for years; the option to pursue otherwise is unacceptable. The opportunity at-hand will thrive with hard deployment of modern population management and technology while providing high-quality patient care at an efficient cost.

This is a major shift from the somewhat unpredictable changes of managed care and the limitations of a messenger-model IPA. This blog has addressed a future of “risk-reward” contracting for several years. We have both recollections and first-hand knowledge of how physician organized delivery systems (PODS) can work. We have gloried in the PODS’ ability to save the patient hassle and cost while paying the practitioner based on results. Now the market and government changes are supportive to “risk-reward” initiatives.

The plan is to select practitioners (Specialists & PCPs, mid-level providers, allied health practitioners, Chiropractic Physicians, etc.) who are candidates for engaging in a physician organized delivery system. That is the goal. The MSO is at work to build IPA capability and inter-disciplinary collaboration with every possible avenue of IPA member participation.

Much more to follow…