The BPCI Advanced: The Next Generation of Bundled Payments from CMS

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The United States Centers for Medicare & Medicaid Services (CMS) has introduced a new voluntary bundled payment model initiative known as the Bundled Payments for Care Improvement Advanced (BPCI Advanced).

Announced at the beginning of 2018, the BPCI Advanced has come in within just months after several mandatory bundled payment programs were canceled. During their initial phases, bundled payment initiatives had exhibited great promise. But later on, many challenges, ranging from identifying patients, understanding provider claim inputs and defining effective strategies, cropped up. The design of the new BPCI program has renewed the interest in episodic cost management as it counteracts the risks and complex implications connected to the former Medicare program MACRA.

Understanding Bundled Payments

Building up a high quality, but affordable and accessible healthcare system that puts patients first, is the foremost goal at CMS. Previously, Medicare used to make separate payments to healthcare providers such as hospitals, post-acute care providers, physicians, etc. for each and every service performed for their patients irrespective of whether it was a single and short illness or a prolonged course of treatment. But they discovered that this payment model resulted in fragmented care, a lack of patient engagement and coordination between providers and healthcare settings. Care providers were being rewarded for the quantity of services offered rather than the quality of their care.

Bundled payments for care improvement which align incentives for providers were more effective and efficient as it encourages them to work closely together across all settings and specialties. All the payments of multiple services that beneficiaries receive during an episode of care are linked together. Healthcare providers involved in this payment arrangement are held accountable both performance-wise and financially for episodes of care. This leads to better patient engagement, coordination and more value-based care at a lower cost to Medicare. Those receiving the bundled payments may either end up with gains or losses depending on how successfully they handled their resources and costs during each episode of care.

CMS Announcements on BPCI Advanced

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The BPCI Advanced is classified as an Advanced Alternative Payment Model (APM) under the Quality Payment Program. The first group of participants are set to be active from October 1, 2018, and the model period performance will be for three months, till December 31, 2023.

All applications were processed via the BPCI Advanced Application Portal. Applications submitted outside of the Application Portal were not be accepted. Incomplete applications were also rejected. As per the plan, Target Prices are to be calculated and distributed to the applicants before the first performance period of each year. The target prices for this year are expected to be distributed in May 2018 and the applicants have time up to August 2018 to sign their participation agreements.

Read More: http://www.lifecyclehealth.com/blog/2018/4/9/the-bpci-advanced-the-next-generation-of-bundled-payments-from-cms

Clinical Episodes in BPCI Advanced Model

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CMS has announced that the Bundled Payments for Care Improvement Advanced model will test a new iteration of bundled payments for 32 Clinical Episode which includes 29 inpatient Clinical Episodes and 3 outpatient Clinical Episodes. Participants of the BPCI Advanced will be held accountable for one or more Clinical Episodes from the launch of the program in October 2018 and are not allowed to add or drop such Clinical Episodes until January 1, 2020.

Inpatient Clinical Episodes

  1. Disorders of the liver excluding malignancy, cirrhosis, alcoholic hepatitis
  2. Acute myocardial infarction
  3. Back & neck except spinal fusion
  4. Cardiac arrhythmia
  5. Cardiac defibrillator
  6. Cardiac valve
  7. Cellulitis
  8. Cervical spinal fusion
  9. COPD, bronchitis, asthma
  10. Combined anterior posterior spinal fusion

Outpatient Clinical Episodes

  1. Percutaneous Coronary Intervention (PCI)
  2. Cardiac Defibrillator
  3. Back & Neck except Spinal Fusion

The Conveners for BPCI Advanced program

From hospitals and physicians to post-acute providers, multiple independent parties are engaged in delivering patient care across an episode. An organization that brings together these various care-providing parties is called a convener. The convener distributes the above mentioned bonus or pays the penalty incurred with higher than benchmark FFS costs. The BPCI Advanced program applications were due on March 12. Starting on Oct. 1, 2018, the participants are subject to immediate downside risk.

Any organisation can play the role of convener, but they must have adequate administrative capacity, the financial capacity to take on the risks and the ability to gain the trust of the various bundle participants. Hospitals, large physician groups, third-party consultancies, or specialty associations like the Academy of Academic Medical Colleges can serve conveners who rally local providers into agreements.

Lifecycle Health’s has designed a healthcare care coordination software platform where all individuals involved in patient’s episode of care, including the patient and all the care providers, are able to coordinate and collaborate throughout the treatment episode. Though it may seem like greek to most, our team of experts at Lifecycle Health understand what CMS is looking for. The Lifecycle Health cloud platform organizes and links the key metrics from given Medicare claims data and makes informed suggestions that saves providers time and costs. From quality of care to costs and patient satisfaction, the Lifecycle Health platform allows its members to get real-time visibility into a patient’s episode across the various providers involved. Allow us to guide your organization to efficiently master the all new bundled payment program, the BPCI Advanced.

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Growing Significance Of Value-Based Care Programs For The Purchasers

Financial growthThe healthcare industry in the United States widely differs from the other countries in finance distribution and other aspects. Other countries follow a universal insurance program that is administered publicly. However, in the US, a huge number of private and public insurance programs finances healthcare and these programs are administered by the purchasers.

Medicare and Medicaid are the primary group purchasers who invest in the public healthcare programs. Apart from that, purchasing cooperatives and employers of different organizations are the purchasers for the private healthcare programs. The last decade saw a rise in the number of public as well as private healthcare purchasers.

Purchasers Demanding Transparency

With the advancement in technology, things have become more streamlined and both these types of purchasers are demanding transparency. Instead of simply giving away the checks to the healthcare providers or the insurance companies, they now are eagerly looking into the entire process. The purchasers now want to measure, monitor and improve the healthcare quality they are receiving.

It means that they want to have a clear-cut idea about the type and quality of healthcare service they are paying for. The way of approach may be different varying from one purchaser to the other. However, collectively this approach has been termed as value-based purchasing (VBP).

Health Care Quality Is The Major Criteria

Over the years value-based care purchasers have become more alert and are demanding a look into every billing footed by the insurance company or the healthcare institutions. One of the reasons is that the healthcare costs have grown rapidly in the last two decades which has even outpaced the economy growth worldwide.

Since this increase in the healthcare costs have come at a time when economic uncertainty is looming on the horizon, many employers are now forced to question whether their expenditures in the healthcare field are really worth. Moreover, recent evidence also suggest that despite paying the competitive pay for the healthcare services, the purchasers have been provided with poor quality service which also includes misuse of the money, medical errors, and waste.

Even though a lot of activity is underway when it comes to value-based healthcare, its impact on the healthcare costs and quality is yet to be established. Hence it is very much important for the purchasers to evaluate these activities and identify as well as establish and adopt tactics that are beneficial for them and avoid those that have been found to be of no use.

Defining Value-Based Purchasing

The definition can vary a bit depending upon the type of purchasers. However, broadly speaking you can refer to value-based purchasing as any practice that aims to improve or add value to the healthcare services. In this case, the value should be taken into account on the parameters of cost and quality both being equally important.

In other words, the primary goal of value-based purchasing is to improve the healthcare quality provided to the patients and others who are receiving these services.

Significance Of Adopting Value-Based Techniques As Healthcare Purchaser

By adopting value-based techniques the healthcare purchasers can expect to fulfill their several goals. These include:

1. IMPROVEMENT IN HEALTH STATUS

One of the primary reasons to focus on value-based techniques is to improve quality. And the implementation of this feature can lead to changes in the health status of the communities as well as individuals.  It is important to be realistic while evaluating the impact of VBP activities on the status of health and also to recognize other factors that can make an impact on the outcomes.

2. GREATER SATISFACTION

Implementation of VBP activities leads to greater satisfaction both for the purchaser as well as the patient/ community. Although it is many times difficult to assess one main reason for the improvement in satisfaction level, more often, it has got to do with quality.

3. REDUCTION IN EXPENDITURE

One of the primary goals of these activities is to cut down the cost of healthcare service. From measuring the premiums to the payments made to the providers, the purchasers focus on every aspect of the payment that goes through them for paying the healthcare services offered to the patients. They can also plan to save on this expenditure by initiating few regular checkup programs.

For example, starting an asthma care unit can cut down the emergency trips to the hospital thereby reducing the expenditure.  Another example, patient monitoring after the primary procedure or condition diagnosis outside the clinic environment, can help in knowing if the patient really needs all of the services along their recovery path. There many additional ways that move from a mindset of “reactive” to “proactive” healthcare monitoring and services.

4. ENCOURAGING HIGH-QUALITY PLAN SELECTION

Another indirect object of the VBP activities is to motivate and encourage the selection of high-quality health plans and providers that includes nursing homes, medical groups, and hospitals. The theory behind this is that if the individuals are able to choose high-quality healthcare programs and providers they are at an advantage of experiencing major improvements in their health status.

5. APPROPRIATE USE OF HEALTH CARE SERVICES

Purchasers also aim to reduce inappropriate utilization of healthcare services through the VBP activities such as antibiotic prescriptions for viral infections or unnecessary Caesarean Section. On the other hand, appropriate utilization of healthcare facilities such as preventive care screenings like mammograms and carrying out recommended immunizations can be encouraged.

Reduction In Medical Errors

Lately, major healthcare purchasers are keenly looking into issues concerning the patients and their safety. More often, their VBP programs are targeted at reducing the medical errors through better patient engagement and cutting down omission errors such as wrong diagnosis, or failure to diagnose a particular health condition needing immediate treatment or errors of the commission such as wrong surgical procedures or overdose of a medication.

Naturally, reduction in medical errors is bound to improve the quality of the healthcare service and reduce its overall cost as well.

Value-Based Health Care Models

As of now a lot of healthcare organizations such as Geisinger Health System, Cleveland Clinic, and Kaiser Permanente are trying out a variety of value-based models and are ready to take a financial risk so that spending can be controlled in a major way. The Deloitte Center for Health Solutions has already come up with several models like:

  • Shared Savings
  • Bundles
  • Shared Risk
  • Global Capitation

These models can surely help the purchasers and the healthcare systems to move ahead in the direction of paying for value.

Using Telehealth To Improve Value-Based Service

Video visits are helping the providers largely to provide personalized care for the patients. That is why there is a growing demand for telehealth as it not only cuts down the cost but also improves the patient engagements-both the factors that are at the core of any value-based program.

Telehealth has a broad meaning and includes various activities such as mobile apps, email consults, activity-tracking wristbands, and clinician-patient video visits. The 2015 American Well Telemedicine Consumer Survey has revealed that 64 percent Americans are more willing to have a video visit with their caregiver rather than going to his clinic and wasting time in commuting.

Using Digital Health Patient Management platforms to Automate and Enable Monitoring of Patients

Digital Patient Management platforms, such as Lifecycle Health and others, help in solving one of the toughest problems that an accountable provider has:  How do I monitor, track and engage my patients after the visit, procedure, or in other words “leave the clinic or hospital”?  This problem is not financially feasible to manually tackle through additional nurses, patient navigators, and coordinators — it adds to the cost of care, which is the opposite direction the provider needs to go.

 

Utilizing a sophisticated platform to automate routine physician “rounds” for recovering patients or monitor key data points for congestive heart failure patients, orthopedic hip and knee replacement patients, spinal procedures, and any other key patient procedure is critical to reducing costs, but more importantly feasibly being able to monitor and engage the patient outside the provider location.

Behavioral health patients for alcohol, drug and opiate conditions can also be engaged and nurtured along their recovery paths. Monitoring and helping not only the patient, but also engage the circle of caregivers supporting that individual along their recovery.

With the patient care continuum improving largely due to value-based service and digital enhancements in medical technology, purchasers are certainly keen to adopt these new changes and make such VBP activities a major part of their healthcare programs.

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If you are looking for any such telehealth video or patient management platform to help your organization more efficient and effective then, Lifecycle Health is the one you can trust. Not only does it is great at arranging quick and effective patient video visits, but it can be effectively used with other providers to monitor patients along the continuum.

Importantly, Lifecycle health also allows you to do a lot of other after-visit activities such as monitoring patients, follow-up visits, communicating and messaging the patients efficiently in a secure way, and much more.

Engagement, monitoring, telehealth video and telehealth messages — Both web and mobile — all available on one single platform! To know more about this highly sophisticated value-based healthcare platform please visit: http://www.lifecyclehealth.com/.