So you want to apply for BPCI-A — here's top tips to prepare your team for downside risk

As part of the push to value-based care, CMS is testing a new iteration of bundled payments which calls for increased coordination among clinicians. The voluntary payment model — the Bundled Payments for Care Improvement Advanced program — may seem daunting at first, but medical groups have found success when they approach the model in an organized, physician-approved way.

Bundled payments incentivize physicians to provide more efficient services and improve care coordination. Bundled payment models lump together government reimbursement for all medical services performed during a single procedure, such as a knee replacement, in a comprehensive package rather than paying for each individual line item. To maximize their margins, providers who receive bundled payments are often more conscious of how they manage their resources and the total costs of care throughout each episode.

BPCI Advanced succeeds the current voluntary BPCI program terminating this September. BPCI-A allows participants to take on financial risk for 32 episodes of care compared the 48 episodes in the current program. One of the greatest drivers for providers to apply for BPCI-A: greater opportunity to profit from episode savings through downside risk. Physician groups and hospitals can participate in BPCI-A by either directly taking on risk for episodes or by joining a convener, a third party that helps share downside risk and provide operational support.  

In a Feb. 28 webinar hosted by Becker's Hospital Review and sponsored by Signature Care Management, orthopedic surgeon John Tessier, MD, with Signature Medical Group, described how his multispecialty practice flourished under BPCI and shared his tips and tricks to help others achieve the same success under BPCI-A.

Signature Care Management, a subsidiary of Signature Medical Group, was one of the original conveners in the first round of BPCI, says Matt Civili, Signature's senior director of program management, adding that it is currently the only physician-led convener in the program.

Signature Care Management partners with about 55 practice groups and 385 hospitals spanning nearly 27 states to coordinate episodic management. It provides a range of services, including social workers, regional case managers and financial analysts, to enhance private practice efficiency under BPCI.   

"The integration of [an] entire coordinated group of talent people … really can help a busy practice transform to start working smarter not hard," says Dr. Tessier. "This has an immediate impact in delivering our services."

What should a strategy consist of?

A comprehensive BPCI solution considers pre-operative, acute and post-operative care. During the pre-op period, teams are brought together for full assessment and care planning before the surgery is scheduled. This planning considers a patient's unique biological, psychological and social needs like body mass index or whether they are a smoker, to identify patients with the greatest potential risks during or after surgery. Then, the patient is educated about his or her upcoming episode of care and surgery is scheduled. Following the procedure, a successful strategy requires working with the hospital discharge planning staff and communicating with the patient's preferred providers. Last, care is coordinated extensively for 90 days post-op, including  physical therapy needs, skilled nursing facility stays and the post-op visit.

"It's looking at the individual parts of healthcare as they existed traditionally and trying to put together a process in order to eliminate waste and improve patient outcomes while also aligning community resources, such as the hospitals, the physicians, the skilled nursing facilities, therapy centers, home health organizations, all working together in order to achieve the best possible individualized care for each patient that enters the episodic care management model," says Mr. Civili.

3 key aspects to managing patient risk and driving bundled success

1. Physicians must be involved. Physicians should pool their resources and be engaged with BPCI programs. They must discuss and implement certain standardized protocols to follow for procedures and set discharge expectations with patients from the get-go. Nominating a physician champion to lead these efforts can contribute to more successful outcomes, Dr. Tessier says. That leadership can guide strategy and data analysis, and ultimately lend to improved outcomes.

2. The case manager is the engine driving BPCI. At the heart of care redesign is the case manager, who tends to be a real difference maker in patient outcomes. Case managers help to organize support networks that develop patient-centered care plans and implement them alongside physician protocols. The case manager is continually engaged with office staff and post-acute care providers.

3. How a technology solution can help. To drive care redesign, care transition platforms are crucial. Signature developed CareMosaic to help provider groups streamline operations in the BPCI Advanced program. Mosaic is a dual-facing analytics platform designed around care transitions and the case manager's responsibility of organizing patients' episodes of care.

The tool aggregates and organizes patient reported outcomes and facilitates collection, reporting and benchmarking of data. It features HIPAA-compliant messaging to drive patient engagement and breakdown communication barriers between patients and their physicians. CareMosaic's data analysis aspect allows for multiple levels of analytics to highlight where there are opportunities for improvement.

CareMosaic also offers a mobile solution that lets physicians see, in real time, where patients are in the care pathway. The app lets care team physicians access each others' notes and communicate among themselves.

Deadlines

The deadline to apply to participate in BPCI Advanced is March 12, and participants will declare their final intent to participate by Aug. 1. The BPCI Advanced performance period will run Oct. 1 to Dec. 31, 2023.

Under BPCI Advanced, medical practices can drive down patient costs and achieve greater patient satisfaction and outcomes, but a comprehensive strategy is necessary for success.

To access the webinar recording, click here.

To learn more about Signature Care Management, click here.

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