Tag Archives: Bundled Payments

How Bundled Payments is Driving Care Transformation and Patient Engagement

Post by David Lee

Product Marketing Manager, Caradigm

Bundled payments was one of the most discussed topics at the recent Caradigm Customer Summit, our annual gathering of industry leaders to share best practices in population health and information security. Matt Stevens, Senior Director with The Advisory Board highlighted bundled payments in his presentation as a program that CMS believes will push the needle in reducing cost variability while improving outcomes for high volumes of patients. He said more mandatory bundles (e.g. cardiac, expansion of Comprehensive Care for Joint Replacement) could be coming and that the intersection between bundled payments and MACRA is only likely to grow as it could become tied to the Advanced Alternative Payment Model (APM) track in the future. Matt recommended that hospital systems prepare to deliver both a broad clinically integrated network as well as excellence in individual bundles that can be decoupled and offered to patients in ways that offers them greater value.

We also heard a number of provider organizations (St. Luke’s University Health Network, United Surgical Partners International, Genesis HealthCare and Greenville Health System) explain why bundled payments is one of the most important pieces of their overall value-based strategy. The bundled payment program drives operational learning and experimentation so that expertise and care process improvements can be built, which then trickles down to other parts of the organization and to multiple populations of patients (e.g. Medicare, commercial populations). As that expertise grows, workflows improve and patient quality metrics improve (e.g. reduced readmissions, lower utilization), Our customers said this helped them gain confidence to scale their programs and also engage in additional value-based initiatives.

Another key aspect of bundled payments discussed was that it pushes providers to develop a high-touch patient engagement model. We heard from everyone that developing patient relationships is not easy, and that they take time. Not only is it a major change for patients to communicate more frequently with providers, the conversations are also different. For example, providers are now discussing with patients why it could be beneficial in certain situations to recover in their own homes rather than stay in a skilled nursing facility. We also heard one customer say that patients often hang up on them during a follow-up call thinking it’s a solicitation call. In this shifting dynamic, providers are trying to establish the groundwork for deeper patient relationships earlier in the care process so they can set the right expectations ahead of time.

Overall, it was exciting to hear that the bundled payments program is having a meaningful impact on patient outcomes and is helping organizations achieve financial success in value-based initiatives. We heard throughout the Caradigm Customer Summit that population health is where healthcare has to go to improve the health of the highest-risk patients. Bundled payments is a key program that will help healthcare providers advance down the path to population health. If you’d like to learn more about how Caradigm is supporting bundled payment initiatives through its enterprise care coordination software, then please send us a note here.

What are Bundled Payments Really About?

Post by Neal Singh

Chief Executive Officer, Caradigm

It wasn’t that long ago that the healthcare industry was trying to agree upon a definition of population health and you’d see articles like this one that tried to explain it. It’s actually pretty remarkable how in a short period of time, provider organizations have made great strides in adopting strategies and building technology infrastructure to adapt to value-based reimbursement models. We’re now entering the next phase of population health where the industry can apply learnings and iterate to hone in on the strategies that will actually yield better value for patients – improved outcomes at a lower cost. One of the most important programs that many providers are adopting is the Bundled Payment for Care Improvement (BPCI) program. Let’s explore the topic further.

Why do we fundamentally need bundled payments? Patient outcomes and costs have to be viewed holistically. The care of patients and payment of services for a single course of treatment often requires multiple providers in multiple care settings, but has historically been siloed. For example, a patient needing a hip replacement requires care from a host of clinicians including a surgeon, anesthesiologist, radiologist, care manager, physical therapist, home health aide, pharmacist, etc. In a fragmented health system, care is not coordinated between providers, which leads to inefficiencies and variability. In order to incentivize coordinated and standardized care, The Centers for Medicare and Medicaid Services (CMS) will now pay a single payment for all of the services performed to treat a specific episode of care in the BPCI program in four models, as well as will hold providers more accountable for patient outcomes such as readmissions. Bundled healthcare services are also making waves globally as they are being applied successfully in multiple countries including Germany and the Netherlands.[1]

I believe this is a significant step towards delivering better value to patients. Approaching the delivery of healthcare as an episode that takes place across the continuum increases visibility and accountability for both outcomes and costs. When measuring outcomes, if providers look beyond what they directly control to the full cycle of care, they will be able to identify new areas of improvement. The beauty of BPCI is that improving outcomes (e.g. speeding up time to begin treatment, reducing complications such as infections that lead to readmissions), often leads to lower costs. Likewise, by looking holistically at costs, providers will be able to determine new areas of improvement such as how quality care can be delivered by the appropriate and most cost-efficient clinician in the appropriate and most cost-efficient facility.

In the short-term, there could be shared savings opportunities as waste and inefficiency are removed. In the long term, repeatability and continuous refinement will lead to excellence in specific episodes of care that can help secure additional contracts. Providers will also be able to apply the improvements in care outside of the Medicare population so that other populations can benefit. As providers become domain experts in their areas of strength, they will set the benchmark for clinical outcomes and cost reduction for the rest of the industry. That’s healthcare transformation.

BPCI does however create some new challenges for healthcare providers. It links specialists, primary care and post-acute care services in a way that will force providers across the continuum to collaborate and change existing practices and workflows. Providers will need to integrate care and thus share data from health IT systems across sites within their health system and with external providers to improve the coordination of patients moving between different settings. These are significant barriers given that legacy health IT systems were not designed to support these types of integrated workflows. Innovation in health IT is required such as the sharing of patient data (e.g. lab results, care plans) in real-time across multi-EMR environments and streamlined workflows (e.g. automated role-based tasking, tracking of patients across the continuum, secure messaging).

I firmly believe that BPCI will expand rapidly and that it will become one of the key levers helping providers effectively transform healthcare delivery and drive better outcomes for patients. It’s a provider and patient friendly program because it is not focused on reducing utilization, but focused on improving efficiency and accountability for quality and costs. It also supports the CMS goal of interoperability and the broader direction of accountable care organizations and clinically integrated networks. Stay tuned for future blog posts where other members of the Caradigm team will explore bundled payments in more detail including how Caradigm’s award-winning care coordination solution supports BPCI workflows.

[1] Bundling Payments to Promote Integration and Efficiency. The Commonwealth Fund. Originally published: http://www.commonwealthfund.org/publications/international-innovation/apr/bundled-payments-to-promote-integration-and-efficiency