June 08 2018 By: Benjamin Swails

You won’t believe what we just heard at the Bundled Payment Summit…

This week our team set up camp at The National ACO, Bundled Payment, and MACRA Summit. With all the buzz about BPCI Advanced, we almost forgot about CJR – and it seems like some providers may have too.

Yesterday morning, Christina Ritter, Ph.D., a Director at Patient Care Models Group (PCMG) and Former Deputy Director of the Hospital and Ambulatory Policy Group for the Centers for Medicare and Medicaid Services (CMS), gave an update on CMS Bundled Payment Policies.

The session covered the goals of bundled payment programs, the case for participating, rules of the various models, and lessons learned from early adopters. But one of the most interesting things we heard is that some providers under the mandatory CJR bundle aren’t doing anything about it! We are already two years into the five-year program, and according to Ritter, many providers still do not have a great understanding of the keys to success in the program.

Just this week (on June 4th), participants in the CJR program received their reconciliation reports. Some groups were pleasantly surprised, while others are left wondering what happened.

Shockingly, few organizations realized they stood to gain or lose up to 5% of their target price this model year – on a $30k episode, that’s a potential $1,500 bonus per episode. Multiply that by an average of 750 episodes (for a high-volume hospital) per year and it’s a number that healthcare leadership can’t afford to ignore. And this number is only increasing, next year participants will be on the hook for up to 10% of the target price.

While some motivated participants took fast action to put the proper systems in place, the mandatory nature of the CJR program has unfortunately led to a wait-and-see attitude from many provider organizations. If your organization was hit with a penalty or a smaller bonus than expected, don’t despair. There’s still hope.

In fact, Clarify’s CEO, Dr. Jean Drouin gave a presentation at the Summit on how organizations like John Muir Health have seen significant improvements under the CJR program using advanced analytics to answer three key questions:

  • Where do we stand in the CJR program?
  • Can we generate actionable insights that will engage our physicians?
  • What actions should we take to optimize care, deliver a great patient experience, and ensure we realize a bonus?

Analytics, insights, and support provided by organizations like Clarify Health enable health systems in bundled payment programs to:

  • Understand their performance
  • Effectively engage physicians
  • Make decisions more rapidly
  • Prioritize where to focus

To learn more about how your organization can implement advanced analytics for success in value-based programs check out John Muir Health’s case study or get in touch with us at [email protected].

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