July 16 2018 By: Adam Travis, MD

9 senior healthcare leaders surveyed at Hospital Association Meeting agree “Opt-out option” makes BPCI Advanced program more attractive

Benjamin Swails, Director of Business Development at Clarify Health, recently attended the Tennessee Hospital Association Meeting with healthcare executives from across the state. As the transition to value-based care remains a hot topic, leaders discussed strategies for success in bundled payments, risk-based models, and quality improvement initiatives.

Just prior to the meeting, over the July 4th holiday, CMS announced an “opt-out” option for participants to retroactively withdraw from the Bundled Payments for Care Improvement Advanced (BPCI-A) program without penalty. This announcement resulted in a tangible shift in perspective for many executives at the event.

Here’s what we heard:

  • The program is more attractive knowing that providers will have more time to analyze performance and make a final decision on participation – risk-free
  • This is a one-time chance to get invaluable claims data from CMS
  • Many executives fear their competitors will be taking advantage of this data to distinguish themselves in the market

Because of the new withdrawal policy, with the right analytics partner, there is no risk in applying to “riskier” episodes. Instead, you will have an opportunity to test efficiency improvement initiatives and assess your performance half-way through the year before making a final decision.

That said, you will still need three key capabilities to ensure success in BPCI-A improvement initiatives:
Real-time bonus / penalty forecasting during the performance period: At the end of the performance period CMS will be calculating a per-patient target price for each episode, so you’ll need an analytics partner that is able to replicate the target price at an episode level in real-time to understand at any given time how you’re performing.

Performance trends: In order to make an informed decision in March about which episodes to continue participation in, you’ll need to know your efficiency performance relative to the baseline period used to set your target price and trends in efficiency performance to accurately project year-end performance.

Precise case-mix adjustment of actual performance to engage physicians on change: In order to engage physicians on behavior change, you’ll need the ability to compare their performance on cost or other operational metrics (e.g. SNF utilization rate) to peers having a similar case mix. This requires more sophisticated predictive models incorporating individual patient factors, vs. a simple DRG-based case-mix adjustment.

If you have questions about what the March 2019 withdrawal could mean for your business, Clarify is here to help. Our unparalleled Clinical Transformation and Implementation team, made up of clinicians with operational and business experience, is here to advise and guide on whether or not you want to enter new episodes. Contact me at [email protected].

Don’t forget to check out our BPCI Advanced Insights eBook: get your copy!

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