How Dignity Health, naviHealth partner to tackle bundled payments

Bundled payments, where reimbursement for an episode of care is lumped together, have continued to emerge as hospitals aim to reduce costs, maintain accountability for quality, and encourage coordination among providers throughout the care continuum.

In January, CMS revealed its new voluntary bundled payment program, the Bundled Payments for Care Improvement Advanced Model. The program, slated to begin in October, will initially include one model with 32 clinical episodes. It will follow BPCI 1.0, which consists of four models primarily with 48 clinical episodes and ends in September of this year. Additionally, CMS canceled the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model, and finalized changes to the Comprehensive Care for Joint Replacement Model in November. CJR is no longer mandatory for hospitals in 33 of the 67 geographic areas chosen to participate in the model.

At the Becker's Hospital Review 9th Annual Meeting on April 12, Harrison Frist, president of provider solutions at naviHealth, and Diwen Chen, executive director of payment innovation and accountable care at San Francisco-based Dignity Health, discussed how partnerships help provide support amid the developing bundled payment landscape.

As a BPCI convener, naviHealth, a Cardinal Health company, provides Dignity Health with post-acute care management services, such as care coordinators with post-acute care decision support, patient engagement tools, post-acute care network formation and management and BPCI analytics, according to a conference presentation. Reporting and advisory services provided to Dignity by naviHealth may include leveraging clinical decision support analytics and claims-based referral pattern data to inform decisions on patient discharges.

The partnership began five years ago. Initially, the decision was part of Dignity's strategy to increase its focus on population health and improve its management of value-based care contracts, according to Ms. Chen. Since then, she and Mr. Frist agreed Dignity Health has experienced success when determining the appropriate post-acute care level for patients, optimizing use of skilled nursing facilities and reducing readmissions in the BPCI 1.0 program for retrospective acute and post-acute care episodes. For instance, Dignity Health has seen an 8 percent reduction in 90-day readmissions since program launch. Skilled nursing facility utilization has also decreased 8 percent in the program over the course of the partnership thus far.


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