The open window to apply for CMS’ Bundled Payments for Care Improvement (BPCI)-Advanced closed on June 24, 2019, but there’s still plenty of opportunity for health systems to move forward with value-based care and care management initiatives — and the care redesign they represent.
Authored by Tamara Cull, DHA
Here are three ways participating in BPCI-Advanced – or getting started with another bundled payment opportunity – can help you build a strong care management foundation:
1. You create a foundation that can scale.
Whether you apply for BPCI-Advanced or elect to work with the many other payers who are creating their own bundled payment initiatives, your initial strategic planning efforts should be considered foundational work.
No health system should ever build a care management model for a single payer or payer program. Whether you’re running a commercial bundle or a CMS-sponsored one, the work is roughly the same. That is, regardless of what payer is sponsoring the effort, you still need to move through the care redesign process to get to the optimal new model for the patient populations you’re targeting.
That includes establishing benchmarks and metrics for success at the beginning, so you’re able to capture the journey and repeat it when you’re ready to expand your efforts across populations and with other payers.
Building economies of scale into your model will help value-based programs work effectively, and it’s where the savings will add up. The alternative is daunting: constructing programs from scratch each time you add a population group or work with a new payer.
2. You build new relationships designed to benefit populations.
It’s useful to see bundled payment models foremost as care redesign opportunities, rather than simply a financial model sponsored by different payers. As such, success truly resides in rethinking the way health systems deliver care.
That means creating new relationships among physicians, health systems and payers who are committed to working together to build the new clinical care pathways that ensure patients are appropriately cared for across the entire care continuum. Within that outlook is also the opportunity to build stronger partnerships with post-acute partners, with the goal of collaborating to drive better costs, outcomes, and other successes across your organizations and your community.
Bringing together people who’ve never been at the table together before opens new avenues to modify decision points and processes end-to-end. In partnership, organizations can start to improve patient care and create new levels of value in ways we’ve only begun to consider.
3. You can capitalize on successes.
If you’re like many health organizations, you’ve already worked to improve your service line effectiveness. You can maximize those benefits by bringing them to your care management efforts as part of payer-led bundled payment offerings.
Another benefit of enhanced physician partnerships if you’re participating in BPCI-Advanced: you may be able to avoid revenue hits from MACRA since the program qualifies as an advanced payment model.
You’ve no doubt seen that value-based programs, whether led by CMS or commercial payers, are continuing to evolve. Likewise, you must also consider your own programs as an ongoing journey. Being able to mark your progress and adapt and expand your model outward to broader populations will help ensure you’re reaching patients in the best way to positively impact health and costs.
Taking the first step.
If you’ve already opted into BPCI-Advanced, there’s more good news: getting in early means you can maximize the amount of time you’re eligible for funds. If the deadline has passed, reach out to your payer partners to learn about their available and upcoming bundled-payment opportunities.
Moreover, if you’re ready to take the first steps, our Aveus team can help you build a strong, payer-agnostic roadmap for care management success.
We are hosting one-on-one consulting sessions to provide assistance as you consider applying. These 30-minute sessions are an opportunity to help you get your four questions answered and prepare for success in the program.
Limited sessions are available—we encourage you to register today.
About The Author: Tamara Cull, DHA
Dr. Tamara Cull is Senior Vice President of Portfolio Management at Medecision. Prior to her current role, Dr. Cull served as National Director of Population Health Account Management for Catholic Health Initiatives with leadership responsibility for Value Based Programs and Operations. Dr. Cull also serves as Adjunct Faculty for two MHA programs: University of Arkansas, Fort Smith and Northcentral University teaching Health Policy, Organizational Behavior and Population Health courses. Dr. Cull holds a Doctorate Degree in Health Administration from Medical University of South Carolina and Master’s and Bachelor’s Degrees in Social Work. She is a recognized national speaker on Population Health. Dr. Cull’s passions are healthcare innovation and transformation, care redesign, and value-based care models and focused her dissertation work on the effectiveness of value-based care models.
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