Change and flexibility. These words have become part of the fabric of healthcare delivery. In 2017, clinicians need to regroup, reeducate, and reorganize the way they document their meaningful data to address the objective within the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP). Part 1 of this series appeared in the January issue of Advances in Skin & Wound Care, where MACRA and the Merit-Based Incentive Payment System for CY2017 were reviewed.

To further understand the underpinning of this program, the Centers for Medicare & Medicaid Services (CMS) has developed "Strategic Objectives" for the QPP to guide CMS in "future rulemaking in order to design, implement, and evolve a QPP that aims to improve health outcomes, promote smarter spending, minimize burden of participation, and provide fairness and transparency in operations".1

There are 6 Strategic Objectives for the QPP. In this column, 3 of the 6 objectives will be reviewed, and the additional guidelines will be explored in next month's column. The following objectives are direct excerpts from the CMS's Strategic Objectives for the Quality Payment Program.1

* Objective 1: Improve beneficiary outcomes and engage patients through patient-centered Advanced Alternative Payment Model (APM) and Merit-Based Incentive Payment System policies. It is essential for physicians and other healthcare clinicians to create meaningful partnerships with patients, families, caregivers, and communities to bring their preferences into the care discussion. The QPP provides new opportunities to improve care delivery by supporting and rewarding clinicians as they find new ways to engage patients and families and improve care coordination and population management. Better care coordination can mean giving patients more quality time with their doctor; expanding the ways patients are able to communicate with the team of clinicians taking care of them; or engaging patients and families more deeply in decision making. These activities ultimately can lead to the delivery of higher-value care. The CMS Person and Family Engagement Strategic Plan and the CMS Equity Plan serve as valuable resources to person-centered policy development leading to informed and coordinated care for individuals and communities.

* Objective 2: Enhance clinician experience through flexible and transparent program design and interactions with easy-to-use program tools. Clinician experience is defined as the end-to-end experience when clinicians interact with CMS in the QPP components, including our people, resources, and systems. A true 3-QPP enhancement to the experience will start with supporting clinicians through accurate, timely data; a modernized payment system; and tools that work and add value to their practice. By developing a program that is flexible instead of one-size-fits-all, we are trying to meet clinicians where they are, so that they can make the choice about how to participate in a way that is best for them, their practice, and their patients. Reducing burden, ensuring flexible program design, and improving how we measure cost and quality performance support clinicians in doing what they do best-making their patients healthy.

* Objective 3: Increase the availability and adoption of robust advanced APMs. In the context of the QPP, APM means a model under section 1115A of the Social Security Act (the Act), the Shared Savings Program under section 1899 of the Act, a demonstration under section 1866C of the Act, or a demonstration required by federal law. Advanced APMs focus on reducing overall healthcare costs and improving the quality of care. Alternative Payment Models are highly diverse in their target participants, subject matter, and approaches. Some APMs measure total cost of care for entire patient populations, whereas other APMs may focus on particular episodes of care, diseases, or practitioner types. The theme that ties all advanced APMs together is that they are designed to improve quality and control healthcare costs. The incentives under the QPP available to clinicians for sufficient participation in advanced APMs meeting certain criteria are central to reaching and sustaining the administration's delivery system reform goals for increasing the proportion of Medicare payments through APMs. By setting ambitious but achievable goals for the adoption of APMs, we expect that healthcare clinicians and professionals will move with greater certainty toward these models.

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