Exploring strategies for making bundled payment programs successful

Lyndsey Lord, MBA, BSN, RN, VP of Clinical Services at CipherHealth -

As we recently explored, the Bundled Payment for Care Improvement (BPCI) program has been updated to become BPCI Advanced. As with any new alternative payment model, there are discussions and debates on the effectiveness and feasibility of the programs. In the example of bundled payments, it is unclear whether the savings generated from CJR, a mandatory bundled program, were a result of the mandate or simply the case mix of the population.

Focus on Episodes with Increased Predictability

Bundled payment programs focused on surgical procedures, such as major lower joint replacement, are more predictable than chronic conditions or acute medical events, such as CHF or sepsis. Many patients undergoing total joint replacement have scheduled and planned for this procedure; this means they are educated on what to expect and prepared for their journey to recovery.

Alternatively, patients with sepsis or CHF exacerbation are often admitted to the hospital emergently, with little to no planning or understanding of their clinical progression and transitional care plan. In critical situations, clinical conditions can change rapidly and the multidisciplinary care team is focused on stabilization of the patient, rather than discussing “what comes next” for the patient.

Due to these clinical differences, there is a more structured care plan for a scheduled surgical episode as opposed to an unplanned medical episode. This pre-episode planning allows for predetermined care plans based on a specific procedure, which can increase savings potential.

Automate Low-Value Tasks

To succeed with bundled payments, providers must create care plans that are nimble and able to respond to changing clinical needs of a patient. Automation is critical to ensure that necessary actions are prompted at appropriate times, lessening the probability of key tasks “falling through the cracks” in a manual process.

A surgical care plan may be executed with little to no deviation, while a medical care plan must be dynamic to respond to changing clinical conditions and patient needs. By automating processes related to the care plans such as appointment reminders, preventive and wellness screenings, procedure education, or other tasks, providers can create efficiencies and save valuable resources for higher-value activities.

Enable Effective Provider Collaboration

Because the majority of potential savings exists in containing post-acute utilization, discharge planning and collaboration with post-acute providers is a key function to decrease episodic spend. Leveraging decision support tools to better codify the discharge planning process allows providers to better understand transitional care decisions, which supports process improvement through data review.

Once patients move from one care setting to another, key pieces of clinical data must be shared with the accepting care team. By enhancing communication between providers, there is a greater chance that potential issues will be avoided and that patient preferences are met. Care plans can be created at the initiation of an episode and continued throughout their convalescence.

Driving success within any alternative payment model requires planning, collaboration, and efficient processes. For bundled payments, in particular, reducing total episode cost without sacrificing quality means that participants need to focus on planning and education, automating tasks, and enabling more effective collaboration between providers.

Author Bio

As the Vice President of Clinical Services, Lyndsey Lord, MBA, BSN, RN brings over 15 years of experience in clinical practice, healthcare operations, case management, patient throughput, and healthcare IT strategy to her current role at CipherHealth. Prior to joining CipherHealth, Lyndsey worked with healthcare providers to implement alternative payment models, such as BPCI, and supported clinical care redesign efforts to promote success within value-based healthcare programs. Lyndsey is passionate about leveraging technology and data to assist providers in delivering high-quality, low-cost care.

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