Choose a current health policy and discuss how evidence-based practice has influenced its development and implementation.
Instruction:
Be sure you have first submitted your initial discussion post to this module’s “Initial Post Screening” before proceeding
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
***No AI or plagiarism, Turnitin report no excuse****
A recent and prominent health policy that has been significantly shaped by evidence-based practice (EBP) is the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. This policy, which includes the Quality Payment Program (QPP), serves as a prime example of how EBP has played a critical role in shaping the development, implementation, and ongoing evolution of health policy. MACRA essentially shifts healthcare reimbursement from the volume of services provided to the value and quality of care, emphasizing the use of data and outcomes in driving decision-making and resource allocation.
Development of MACRA through Evidence-Based Practice
Evidence-based practice is rooted in using the best available data, clinical expertise, and patient preferences to inform healthcare decision-making. The journey to MACRA’s enactment and design reflects this principle, as policymakers drew extensively on empirical research and expert analysis to craft a system aimed at improving care quality, reducing healthcare costs, and promoting patient-centered care. Research consistently highlighted the limitations and inefficiencies of the previous fee-for-service model, which incentivized high patient volumes without adequate emphasis on quality care or outcomes. Studies such as those published by the Institute of Medicine (now the National Academy of Medicine) underscored systemic issues like overtreatment, preventable errors, and inconsistent patient outcomes, providing a strong evidence base for shifting to a value-based care model (Woolf & Aron, 2013).
Evidence also showed that alternative payment models (APMs), like Accountable Care Organizations (ACOs) and bundled payment arrangements, led to better patient outcomes while controlling costs in pilot studies and smaller programs. Such findings fueled the creation of the Merit-based Incentive Payment System (MIPS) and incentives for APM participation under MACRA, as these mechanisms directly reward clinicians for care quality, cost-efficiency, improvement activities, and meaningful use of health information technology (Buntin et al., 2017).
Implementation Shaped by Evidence-Based Insights
The implementation of MACRA and QPP relied heavily on evidence and ongoing data collection to ensure it achieved its intended outcomes. Key provisions of the program emphasize data reporting and analytics to monitor and incentivize performance. Healthcare providers must report on specified quality measures, cost measures, and improvement activities, with their performance being evaluated against established benchmarks rooted in prior evidence and clinical guidelines. For example, clinicians who demonstrate high levels of quality care and cost-effectiveness receive positive payment adjustments, while those who underperform face penalties. This system was designed based on evidence demonstrating that financial incentives tied to specific, measurable quality goals can drive behavioral changes in healthcare practice and improve outcomes (Casalino et al., 2016).
The Centers for Medicare & Medicaid Services (CMS) has also integrated continuous feedback loops and stakeholder engagement, utilizing evidence to refine and update MACRA policies in real time. By leveraging data collected from participants, CMS has been able to make evidence-based adjustments to quality measures and payment models, ensuring they reflect the evolving needs and outcomes of patient care.
Influence on Clinical Practice and Patient Outcomes
The evidence-based nature of MACRA has significant implications for clinical practice and patient care outcomes. Research has shown that value-based payment models can lead to reduced hospital admissions, improved chronic disease management, and increased patient satisfaction (Chien & Rosenthal, 2013). Providers are incentivized to adopt evidence-based guidelines and best practices in their care delivery, as meeting these standards is directly tied to their reimbursement and performance ratings. Furthermore, the integration of health IT and data analytics enables more precise tracking of outcomes and identification of areas needing improvement, fostering a culture of continuous quality improvement.
Conclusion
The development and implementation of MACRA illustrate the powerful role evidence-based practice can play in shaping health policy. From identifying systemic issues within fee-for-service models to crafting data-driven solutions and continuously refining those solutions through ongoing evidence collection, MACRA reflects a commitment to aligning healthcare practice and policy with the best available evidence. The ongoing evolution of this policy will continue to be driven by robust data, ensuring that it remains responsive to both provider needs and patient outcomes.
References
- Buntin, M. B., Ayanian, J. Z., & Weissman, J. S. (2017). Healthcare reform and the shifting dynamics of health care practice and policy. New England Journal of Medicine, 376(5), 488-491.
- Casalino, L. P., Gans, D., Weber, R., Cea, M., Tuchovsky, A., Bishop, T. F., … & Miranda, Y. (2016). US physician practices spend more than $15.4 billion annually to report quality measures. Health Affairs, 35(3), 401-406.
- Chien, A. T., & Rosenthal, M. B. (2013). The impact of the Medicare value-based purchasing program on hospital quality. Health Affairs, 32(8), 1419-1427.
- Woolf, S. H., & Aron, L. (2013). US health in international perspective: Shorter lives, poorer health. National Academies Press.