The window of opportunity to apply to CMS' Bundled Payments for Care Improvement Advanced is quickly closing.
The deadline for acute care hospitals and physician groups to submit a nonbinding application to partake in BPCI-A is June 24. Providers who want to secure their option to participate in the program need to act now, Keely Macmillan, general manager of BPCI Advanced at Archway Health, said during a May 23 webinar sponsored by Archway Health and hosted by Becker's Hospital Review.
Under one of 37 clinical episodes offered under BPCI-A, providers are responsible for managing all the costs associated with an episode of care, from initial admission to 90 days post discharge. That is, if a provider is given a $25,000 target spend for a hip replacement, and spending comes in under that benchmark, the provider keeps the savings. If the spending is over that benchmark, the provider would owe Medicare back the difference.
"Value-based models that include both upside and downside risk will eventually be universally applied," Ms. Macmillan said. "Providers need to learn how to assess and manage their risks — and opportunities — in upside-downside risk models. BPCI-A is a great opportunity for providers to dip their toes in the waters of value-based care."
How to think about opportunities, risks under BPCI-A
Once providers submit a nonbinding application to CMS to participate in BPCI-A, they receive three years of historical baseline data as well as preliminary target prices to begin assessing their opportunity.
There are several questions providers need to ask as they evaluate their opportunities and risks under BPCI-A through the lens of these data. Four key ones are:
- How do your episode prices compare to historical performance?
- Do your recent performance trends create opportunities versus baseline performance?
- Does your performance versus regional and peer benchmarks create opportunities?
- What are the probabilities of success within each bundle and across multiple bundles?
The ability to answer these questions is critical for providers to identify which bundles will create the highest value at the lowest risk. These are all questions Archway helps its provider partners answer.
The right solution
Archway developed comprehensive tools for BPCI-A, as well as other bundled payment programs, to help providers — even those with the most sophisticated of analytics teams — assess their risk and opportunities and manage their programs throughout their duration.
"We've taken our experience and honed a successful bundled payment solution that combines strategic planning, analytics, real-time patient tracking, performance tracking and program management. This allows providers to take control of their risk and improve the quality of care being provided for their patients," Ms. Macmillan said.
Archway assists hospitals and physician groups by becoming a direct convener with CMS and managing risk contracts. The company also offers analytics tools to providers that act as their own convener and manage their own contracts with CMS directly. Archway works with hundreds of providers across the country, and its leadership team brings over a decade of experience to its bundled payments solutions. Across the board, Archway’s specialty partners save an average of 9 percent versus baseline cost. Certain groups have saved up to 16 percent. All of this translates to an average of $3,000 in savings per case.
"We really strive to meet providers where they are," Ms. Macmillan said. "The journey from fee-for-service to value-based care isn't straightforward and providers are at different points along that journey."
The second BPCI-A cohort will start Jan. 1, 2020. Right now, CMS doesn't plan to open the window again. So it's really "now or never to look at your opportunity in the program," Ms. Macmillan said.
"Providers who sit on the sidelines of value-based care initiatives will fall further and further behind the curve. When models with downside risk are mandated, your peers who have been participating in these programs will be better prepared and positioned for success. The success that others have in risk models today will dictate your pricing in mandatory programs tomorrow. Providers can not afford to ignore these opportunities."
To view a recording of the webinar, click here.
To learn more about Archway Health, click here.