Smartlink: Facilitating the Transition to MACRA

Siu Tong, CEO, Dr. Alex Tse, CMO On April 16, 2015, in a rare act of overwhelming bipartisan support, legislation was passed that will have a seismic impact on the U.S. healthcare system. Dubbed the Medicare Access and CHIP Reauthorization Act (MACRA), the $214 billion bill fundamentally made a giant leap towards shifting the nation’s healthcare system from fee-for-service to fee-for-value. Up until then, Congress had to repeatedly enact short-term patches to prevent the sustainable growth rate (SGR) formula from going into effect. MACRA at long last repeals the SGR, and replaces it with a new payment system that rewards higher quality and better outcomes, rather than volume. The majority of Part B payments are now tied to value and risk is unavoidable. While the transition to value-based payment models can seem daunting, there are some levers that can be pulled in the short term that can neutralize downside risk. “That’s where we come in,” says Siu Tong, CEO, Smartlink Mobile Systems.

Founded in 2012 by physicians who were frustrated with the lack of affordable, effective, and easy-to-use solutions, Smartlink strategically set out to address some of the challenges to delivering better health outcomes. “Particularly, chronic disease care between clinic visits,” notes Tong. “Eighty-six percent of U.S. healthcare spending is on people with chronic conditions, but in a fee-for-service world these patients don’t get the ongoing care they need between clinic visits. It’s no secret that a more proactive approach to chronic care management is a foundational component of value-based care.” With a solution designed specifically to improve care coordination and care management between patients and all the providers who care for them, Smartlink is tackling some of the fundamental problems in healthcare and is well positioned to impact the success of value-based payment models.

The MACRA Effect

Under MACRA, eligible clinicians that do not participate in Advanced APMs will receive either a bonus or a penalty based on their performance relative to their peers in the Merit-Based Incentive Payment System (MIPS). Approximately 85-95 percent of eligible clinicians will fall under the MIPS payment model. The first reporting period for MIPS begins in January, 2017 and scores will impact payment in 2019. Additionally, scores will be publicly available for patients and commercial payers to use in their decision making. While The Centers for Medicare & Medicaid Services (CMS) has recently introduced a “pick your pace” of participation option for 2017, the clock is ticking and all eligible clinicians are now in a race to outperform their peers. “Given the potential reputational and financial impact of MIPS with both public and private insurers, the risks associated with a “wait and see” approach are extremely high,” points out Tong. Making a successful transition will require a strong emphasis on wellness, prevention, care coordination, and chronic care management. Getting patients more involved in their own care will also be important. “Much has already been written about the importance of getting the right care, in the right place, at the right time. Keeping patients and providers connected and informed is the key. For poly-chronic patients, that means being able to consistently stay in touch with broad populations of patients through non-face-to-face encounters,” explains Tong.

Smartlink has taken a very unique approach to tackling some of the key challenges associated with value-based payment models.

At its core, Smartlink’s solutions are all about improving collaboration and communication across the care continuum, and keeping the patient at the center of it all

They provide a value-based Chronic Care Management (CCM) solution that leverages Medicare’s CCM program (CPT 99490) as a competitive advantage under MACRA and Accountable Care. “In addition to tackling the logistical aspects of care coordination and care management, we have built in to our solution care management techniques and actions learned from working with a population of 1.5 million patients. These methods have been refined over the last 18 years and are proven to improve outcomes,” states Tong. Since this approach provides meaningful value to patients, the solution minimizes patient attrition in the CCM program and also provides an effective foundation on which to target specific quality, cost, and improvement measures under MIPS. For example, disease specific protocols incorporate assessments and clinical triggers. These triggers ensure that clinicians are alerted to early warning signs that might otherwise be missed and result in a preventable hospitalization.

Interoperability is another key challenge that Smartlink tackles. The cloud-based system allows clinics to seamlessly exchange clinical information between disparate EMRs without expensive integrations and interfaces. Clinicians have the right information at the right time, expediting diagnosis and care, all the while keeping the referring clinician in the loop on the patients’ status. “At its core, Smartlink’s solutions are all about improving collaboration and communication across the care continuum, and keeping the patient at the center of it all,” Tong affirms.

Smartlink’s Pocket HealthNet mobile app enhances the patient/provider relationship further by making it easy for patients to communicate and share information with all of their providers. Unlike patient portals that are specific to a physician’s EMR and focus on pushing information to patients, Pocket HealthNet is vendor-agnostic and a one-stop-shop for patients to access the care they need. “In addition to having a bidirectional dialog, patients can manage their appointments, refills, e-check-in, and share clinical documents with their providers,” explains Tong. For clinics, the platform serves as a single communication gateway for all their patients, making it easy to have one-to-one as well as one-to-many communication. “Clinics can broadcast messages to specific populations such as educational materials, health alerts, flu shot reminders, and status requests to help identify potential health issues before they escalate,” asserts Tong.

It Takes a Village

When Medicare’s Chronic Care Management program first began at the beginning of 2015, it quickly became clear that clinicians can’t do it alone. Providing non-face-to-face care management services to patients is completely different than providing episodic care in a clinic. As a result, clinics that have participated in the program by using existing staff end up providing the service to a small percentage of patients, are not consistently touching their enrolled patients, and have trouble retaining patients in the program. “On the surface, providing CCM seems like something that clinical support staff could do in their downtime, but for most clinics that strategy just hasn’t worked very well,” adds Tong.
The new market opportunity created by CCM’s 20 million eligible Medicare patients led many companies to start offering CCM services to clinics.

Rather than jump on the clinical service bandwagon for CCM, Smartlink decided instead to continue focusing on its strength— developing innovative healthcare technology. The company chose to focus on partnering with the best clinical services organizations in the country. That strategy resulted in a partnership with Computer Sciences Corporation [NYSE:CSC], a global leader in population health management. CSC provides care management services to more than 250,000 patients globally, and has an unequalled, proven ability to rapidly scale their high quality services for large health systems. CSC has perfected a high touch approach to care management that improves patient outcomes and satisfaction. When CSC chose to build out a CCM practice, they knew from experience that their ability to maintain a high quality of service at scale would hinge on seamless electronic collaboration with providers, bi-directional exchange of clinical documents with disparate EMRs, operational efficiency, and the ability to guide meaningful dialog with patients. “CSC recognized early on that CCM requires more than just people to do the work and technology to track the time. It requires people, technology, clinical guidelines, workflow, and efficiency in order to truly make it successful clinically and financially,” explains Tong. “They partnered with Smartlink because of our unique ability to address those challenges plus improve MACRA performance.” In partnership with Smartlink, CSC is continuing to grow their CCM practice, providing a fulfilling and effective care experience for patients that results in strong patient retention.

"We have built into our solution care management techniques and actions learned from working with a population of 1.5 million patients. These methods have been refined over the last 18 years and are proven to improve outcomes"

Another strategic partnership for Smartlink has been its relationship with Managing Care Solutions (MCS), based in Raleigh, NC. Founded and led by a physician, the MCS leadership team has more than 18 years of experience managing a population of 1.5 million patients. “Our partnership with MCS has been mutually beneficial,” adds Tong. “MCS has been highly influential in the ongoing development of the Smartlink solution. We’ve been able to bake in a lot of their knowledge and experience, which has really helped set us apart.” Using Smartlink, MCS provides CCM services with very high patient satisfaction and extremely low patient attrition.

Healthcare and Beyond

Smartlink continues to stay grounded in its innovative roots by working very closely with partners and clinics. “We don’t just train, onboard, and run to the next one,” extols Tong. “We nurture, share best practices and new ideas, and support our customers and partners to ensure their success is prolonged.” The company continues to focus on providing easy to use, affordable solutions for effective chronic disease management. “As for our product portfolio expansion, we are in the process of developing the holistic ‘MACRA Solution Suite’ that will help address more real world problems quickly and cost effectively,” assures Tong.

Regimes may change; bills may be passed and repealed, but the focus on transitioning the nation’s healthcare system to one that is value-based will remain. To that end, Smartlink sees a strong future for healthcare organizations that can make the transition faster than their peers. For Tong, it is all about “thinking big, making a big impact, and quick decision making.” Sure enough, this strategy seems to be working well for Smartlink in their quest to make healthcare better for everyone.

Smartlink Mobile Systems

Cary, NC

Siu Tong, CEO, Dr. Alex Tse, CMO

Helping clinics deliver quality care through patient centered chronic disease management

Smartlink Mobile Systems