In today's healthcare system it's not as simple as providing a service for your patient and then getting paid for that service. You have to provide a successful service to get paid. This is a huge shift for patients and healthcare providers. Here's our take and advice on alternative payment models.
Alternative payment models like bundles are here to stay, but their future form is unclear. As payer-provider arrangements shift, providers will remain in a constant state of catch-up.
The results of the incentives initiated with bundled payments (i.e. BPCI) are inconclusive as to the value achieved by providers in their investments to coordinate care. In February 2015, CMS released an initial evaluation of their BPCI program where it was reported that there was increased coordination between acute and post-acute (PAC) providers, but there wasn’t sufficient positive result attributed to the program.
Knowing that coordination of care is complex in fully enclosed care settings (CDC reports more than 700,000 infections acquired in acute hospitals), it is understandable why the investments made among providers participating in BPCI could outweigh the benefits.
Focusing on bundles may cause providers to overlook other high-risk patients.
The efforts that PAC providers take to maintain unique patients (those belonging to bundled payments) from costly unplanned interventions may not only be underestimated in implementation, but also have unintended consequences if a holistic risk management solution is not part of a provider’s toolkit.
A program that deploys a “hunting and pecking” tactic for bundled patients may overlook patients with greater risk (like patient 2 above) and thus cause non-bundled payers to absorb lower quality. See the figure above which displays a group of patients with different levels of readmission risks along with their payers.
Manage your patients according to their risk. This way, patients will receive appropriate care at the appropriate time, which is the underlying objective of CMS quality care programs like BPCI.
Providers who seek a simple and effective approach to managing their patients ought to consider a solution that cuts through patient segments and highlights all at-risk patients.
By segmenting or grouping patients based on risk, providers have positioned themselves favorably, not only with potential partners and patients, but also with payers. Knowing that bundles are only the beginning of testing quality initiatives for healthcare reform, and broader payment constraints are expected, working beyond specific case management will better prepare providers for future reimbursement pressure.
Call to Action:
Invest in technology that leverages analytics to help you pinpoint your high-risk patients and intervene accordingly.
Medalogix Touch helps clinical teams manage patient risk by analyzing patient data to identify and risk rank patients most likely to transfer off the home health census. After identification, Touch helps clinicians intervene appropriately with a calling function. The calling feature works even when the patient is outside the traditional 60-care window--so providers can still deploy touchpoints to those patients who are a part of a 90-day bundle.
Touch is a natural fit to help home health providers manage their riskiest population because readmission risk dictates CMS’s bundled arrangements. To design bundles, CMS evaluated which DRGs had the most impact on readmissions. Since our analytics solution identifies those patients who are most at risk of transferring off a home health census and returning to the hospital, our model mirrors CMS’s 48 DRG conditions.
Learn more about Medalogix Touch here.