2 keys to BPCI Advanced success — data and analytics

As the U.S. healthcare system shifts towards value-based care, CMS is increasingly tying Medicare reimbursement to care outcomes. In October, the agency will roll out Bundled Payments for Care Improvement Advanced, a new voluntary episode bundled payment model designed to reduce costs and improve the quality of care for Medicare beneficiaries.  

In a May 23 webinar sponsored by naviHealth and hosted by Becker's Hospital Review, naviHealth leaders Gina Bruno, vice president of clinical strategy, and Tom Divinnie, director of strategy and business development, discussed how healthcare organizations can harness the power of data and analytics to successfully manage their BPCI Advanced program.

naviHealth, a Cardinal Health company, serves health plans, health systems and post-acute providers by deploying scalable technologies, advisory solutions and clinical services to actively support its partners in the shift to value-based care. The company manages over 40,000 annual episodes of care across 10 states with naviHealth BPCI operations.

4 insights into BPCI Advanced

1. BPCI Advanced is distinct from the inaugural BPCI model in several ways:

  • Baselines and target prices will be risk-adjusted
  • Participants will know the trend factor ahead of a given performance period
  • The wage index will no longer be a distinct factor

2. These changes are favorable for healthcare providers because they allow providers to make more informed decisions when choosing clinical episodes. Participants should receive historical claims data from 2014-16 and prospective target prices for the initial performance period in May. Participants will use this data to select clinical episodes for the program by August.

3. Given that BPCI Advanced qualifies as an advanced alternative payment model under MACRA, the episode groups will influence how eligible clinicians can meet their MACRA criteria. "Episodes need to be selected that match how your organization is investing in care redesign," Mr. Divinnie said. "Based on the review of the historical data, there will be savings levers that become apparent for how total cost of care can be reduced for each episode group."

4. Participants should keep benchmarking and peer group considerations in mind. Benchmark price is calculated using historical Medicare fee-for-service spending adjusted to reflect the provider's efficiency relative to peers over time. BPCI Advanced participants in a small peer group may see a more pronounced change in the target price over time if other providers are successful in driving savings. Ongoing peer group comparison is a moving target, and it is important to stay ahead of the group during the program, according to Mr. Davinnie.

The importance of data and performance analytics

Visibility into program financial performance is crucial. CMS' Net Payment Reconciliation Amount (NPRA) forecasting allows providers to see achieved results and decide whether to expand or reduce the program. Providers must be able to anticipate target price fluctuations based on estimated patient mix.

Tracking key performance indicators highlights opportunities for improvement relative to baseline and target utilization benchmarks. Viewing key performance metrics quarter over quarter optimizes program management by helping providers understand factors driving financial performance, according to Ms. Bruno.

Provider and episode group dashboards supplement standard BPCI Advanced KPI reporting and enable participants to discern which physicians and post-acute care providers deliver quality, cost-effective patient outcomes.

"CMS has made it very clear in this program that the emphasis is on care redesign, on the patient experience and on achieving high-quality outcomes," Ms. Bruno said. "That's really hard to do without data." Performance improvement initiatives require some data to be available before reconciled claims are received. Operational data may come in the form of 837 files, EMRs or care transitions systems. While developing data may not be as reliable as claims data, it can contribute to timely care redesign.

The first step is for providers to identify influencers and key decisionmakers for episode and site selection, setting expectations and eliminating bias in the decision-making process. Then participants should finalize their BPCI Advanced team both internally and with external partners, and establish a strategy for performance monitoring and improvement.

For more on what BPCI participants should do next, listen to the webinar recording here and view the webinar slides here. Learn more about naviHealth here.

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