The Centers for Medicare and Medicaid Services (CMS) delivered the next generation of the Bundle Payment for Care Improvement (BPCI) program on January 9, 2018. CMS refined the original program definitions focusing on volume episodes and expanded the eligibility to include physician group practices including surgical centers.
Medicare data for applicants over the past four years (CY 2013-2016) reveals several key findings regarding bundled payments that reinforce why participation is beneficial. The data shows that bundle payments:
- Help organizations identify and understand true costs
- Provide insights on the utilization of post-acute care
- Provide benchmarks for an organization’s total episode costs by condition and compare them to national averages
- Strengthen offerings by partnering with high performing networks
Considerations to help identify if the BPCI Advance Program or other bundles are right for your organization include evaluating your:
- Bundle strategy: identify bundle elements aligned to your organization’s strengths and avoid those outside of them.
- Risk strategy: consider whether your organization is prepared to own the risk or share risk with another organization or convener.
- Quality strategy: review your current quality programs and determine what improvements and measures to add.
When creating a bundle program, Optum® agrees with CMS* that there are five important building blocks to consider:
- Care redesign: Support and encourage participants, practitioners and episode initiators who seek to continuously reengineer care.
- Data analytics and feedback: Decrease the cost of each clinical episode by eliminating unnecessary or low-value care, increasing care coordination and fostering quality improvement.
- Financial accountability: Develop and test the payment model that creates extended financial accountability for the outcomes of improved quality and reduced spending in the context of acute and chronic clinical episodes.
- Health care provider engagement: Create an environment that stimulates the development of new evidence-based knowledge.
- Patient and caregiver engagement: Offer patient education and ongoing communication throughout the clinical episode.
Participating in the BPCI Advance program creates an opportunity to leverage the right set of bundles to reinforce care pathways and improve outcomes while managing costs. As experience grows with bundle programs, they can be leveraged beyond Medicare into commercial programs.
About the Author:
David Mauzey, General Manager, Optum Network Payment Innovation
Prior to joining Optum, David spent 17 years working with an enterprise network administration and claim pricing organization. Serving as both COO and CIO, David gained a great appreciation for finding the right operational and technical balance that align to organizations’ visions. Today, David focuses on enabling organizations to better administer their value-based contracting programs.
*Source: Centers for Medicare and Medicaid Services. BPCI Advanced fact sheet. Innovation.cms.gov/Files/fact-sheet/bpci-advanced-generalfs.pdf. Accessed Feb. 14, 2018.