If you successfully submitted your application and data request for CMS’ Bundled Payment for Care Improvement Advanced (BPCI Advanced) then you, like many across the U.S. health care system, gave a sigh of relief when the clock struck midnight on June 24. That relief, however, will be brief.
Before Medicare releases requested historical claims data (expected in September), it’s essential that hospitals begin to assess, evaluate, build and refine their various systems and assets to prepare for BPCI Advanced. Below are the key steps institutions should be taking to lay the foundation for achievement of clinical and financial success in the program.
1. Assess your data analytics capabilities for reviewing your historical claims data. After the data are released, you will only have 60 days to review and determine episode selection, so having the proper capabilities in place will allow you to quickly and thoroughly access and process the historical claims data to inform your episode selection.
If you are working with a convener there is value in performing the analysis separately to ensure you get the analyses your system will require and/or your convener’s timeline may not be in sync with your needs.
2. Use benchmarking capabilities to inform and understand post-acute care utilization. This is essential because unlike legacy BPCI, participants in BPCI Advanced are competing not only against their own historical utilization, but against regional peers, risk adjustment factors and other comparisons as well. Having an appropriate benchmark will help you determine where you need to take action, as well as where your opportunities lie. Benchmarking data are available from companies who work in this space such as Sg2 and Vizient.
For example, when comparing an organization’s performance against the Sg2 benchmark database for an orthopedic bundle, a clinical episode appeared to offer a low opportunity for improvement, as the historical spend is equal to the benchmark target price (this is the target to beat for bonus payments under the program). However, further analysis showed that better alignment with a lower-cost and higher-quality post-acute care provider would improve patient outcomes and satisfaction, as well as lower overall costs and modestly reduce length of stay in skilled nursing facilities. Upon seeing this data, the orthopedic surgeons unilaterally agreed care redesign initiatives could be put in practice almost immediately, which would result in not only improved cost and quality outcomes, but also success within the BPCI Advanced program.
Note: Sample data are illustrated in this manner for demonstration purposes only and may not reflect exact deliverables.
3. Prepare your organization’s clinical infrastructure. A strong infrastructure is necessary to implement, oversee and manage the bundled payment initiative, including:
- Governance and support structure: Consider service line-focused committees that include key physicians, care management, finance/IT and service line leadership
- Ongoing data analytics measurement: Monthly reporting and reconciliation every six months are required
- Specialized care navigation: Follow high- and intermediate-risk patients through 90-day care plan
- Narrow post-acute care provider networks supportive of your quality and utilization requirements: Quarterly meetings with post-acute care providers to share their performance has proven effective
4. Begin informative discussions with the necessary physicians and other clinicians. Ensure they understand “business as usual” is not enough to succeed during this sea change in reimbursement mechanisms.
Next, educate yourself on the incentive models that can help align interests and efforts, including those for employed physicians.
Finally, educating your medical staff is also of paramount importance before committing to the program.
The time is now
In general, take advantage of the time you have over the next two months. As previously mentioned, the timeline for episode selection — which occurs once the historical claims data are made available — will be short. Furthermore, it’s important to note that improper episode selection could prove to be financially troublesome, as you will be committed to the episode you select for at least one year.
If you want to be prepared to succeed — not just participate — in BPCI Advanced, don’t wait. Questions about bundled payments? Ask our experts.
