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Welcome to our Newsletter!
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The Merit Health Network is comprised of two physician led entities: Merit IPA and Merit CIN. Our approach is to offer physician practices varying mechanisms to improve reimbursement methods, enhance care coordination, quality, and efficiency to manage our patients' health throughout the entirety of their care experiences. Merit CIN provides a platform for our physicians to collaboratively provide seamless care across provider settings to truly provide our patients the care they deserve, when they need it most. Merit is proactively responding to the pressure on today's independent providers during an era riddled with evolving reimbursement methodologies, provider and payer consolidation, and relentless regulatory uncertainty. Coming together to form Merit provides an opportunity for advocacy efforts to not only sustain independence, but thrive.
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Along with merger activity with payers, MACRA is the hot button of late in our industry. Another acronym that will undoubtedly have a major impact, particularly in physician practices. However, this time, the newest acronym came with friends – QPP, MIPS, APM, CPC+, etc. As expected, with so much other information to administratively process, understanding the details is currently the battle. As we interpret this knowledge, then the questions must be: “Where does your practice stand?” and, “What is your action plan?” With such an abundance of information online to research, leading to an overwhelming paralysis by analysis, Merit seeks to simplify the answers as a continual resource for you and your practice (the more you ask, the more we can answer). Hopefully the information and sources contained in this newsletter and our website will shed some clarity. Be sure to check in and look for our FYI’s, Manager Meetings, etc. to learn more and how Merit can help its members.
Please be on the look out for our All Manager's Meeting and ensure your practice is represented for an interactive Merit update and networking opportunity. Highlights for the upcoming meeting to be MACRA. Hope to see you there.
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The Office of the National Coordinator for Health IT recently released defined interoperability measures as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). These measures intend to clarify what exactly it means to, “achieve widespread exchange of health information through interoperable certified EHR technology nationwide.” As the Department of Health and Human Services received nearly 100 comments regarding the definition and implementation of MACRA’s Interoperable measurements, many of the comments fall into one of four topics. Click HERE to read about the 4 measures required by MACRA.
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CMS Acting Administrator Andy Slavitt Announces Possible Delay to MACRA Start Date
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As referenced in Modern Healthcare (and nearly every healthcare publication….) on Wednesday, July 13th, CMS Acting Administrator Andy Slavitt informed lawmakers of the possible delay to the January 1st start date for Medicare payment reform. Testifying before the Senate Finance Committee, Slavitt expressed concern for small practice physicians, who may not be ready for the changes under the Medicare Access and CHIP Reauthorization Act. Click HERE to read more.
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July 1st
If the proposed Anthem/Cigna and Aetna/Humana mergers are allowed to proceed, the combined entities will control roughly 90 percent of both Georgia's individual health insurance market. Additionally, these entities will subsequently control 90 percent of both the Medicare Title XVIII market and the large group markets in Georgia. The carriers assert that consolidation will improve their ability to operate more efficiently and enhance care quality, however the sheer size of their presence is concerning. Click HERE to read why Georgian physicians believe that the merger alone will threaten the long term viability of their practice.
July 20th
There continues to be developments regarding the proposed mergers between Anthem/Cigna and Aetna/Humana. July 19, the Justice Department reported they will likely file lawsuits this month to halt both proposed mergers. If the Justice Department does take action, it may significantly delay any merger. Click HERE to read more.
July 21st
Department of Justice files lawsuit to stop mergers.The DOJ held their press conference announcing their suits to block both mergers at 11:00. Here are a few takeaways:
- · DOJ believes that the mergers would fundamentally reshape the healthcare market and drastically restrict competition at the expense of consumers, employers and healthcare providers.
- · All four insurers are thriving as independent firms; the mergers are not a mechanism for their survival
- · Mergers represent a convenient pathway to increase profits.
- · Anthem/Cigna: biggest threat is to the employer healthcare market.
- · Aetna/Humana: biggest threat is to the MA market.
Click HERE or more from the press conference
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Merit Independent Physician Association
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Incorporated in 2013, Merit IPA is the region’s premier network of non-affiliated and independent specialists. Currently, Merit IPA is comprised of over 190 physicians representing 22 specialties from 26 individual practices. We are fortunate to be composed of the region’s highest quality and specialized providers, who’s motivation is twofold; First, to improve care via better coordination between providers and, second, to reduce payer cost by avoiding duplicate care. Merit IPA was also developed to provide a vehicle for advocacy at the local and state levels. A platform to have an open dialogue with other providers, payers, legislative officials, and other provider based associations for the purpose of building strength in the foundation of today’s independent provider.
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Merit Clinically Integrated Network
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By reception of legal advisory opinion, The Merit Clinical Integration Network was formally established in late 2015, to offer a platform for providers to coordinate care delivery, reduce inefficiencies, and measurably improve value added to the patient community we serve. Jumpstarting more than a year of due diligence, several members within Merit IPA fearlessly led the necessary effort to pursue CIN functionality and success. We proudly deployed GRAChIE as our Health Information Exchange (HIE) solution to connect with a total of 22 provider entities throughout GA.
Criteria for membership:
- Purchase GRAChIE license
- Data sharing
- Lead or participate in a clinical initiative
- Participate on a CIN committee
- Resource allocation
Benefits:
- Risk-sharing contracts
- Increased payer relationships
- Ability to contract with other CIN and related entities
- Single signature authority
- Partnerships with employers, other providers, etc.
- Care coordination and management
Committee Structure:
- Executive Committee
- Quality Assurance & Compliance
- Finance & Contracting
- Subcommittee: Connectivity & Data Analysis
- Medical Director: Dow Hoffman, MD
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