The voluntary path forward in bundled payments

· 4 min to read

Without question, the current healthcare landscape may be riddled with uncertainty and debate, but one thing is clear, and perhaps, the most promising: the future of our system is dependent on our ability as healthcare providers and leaders to provide higher quality, more cost-effective care for the benefit of the most important stakeholder in the value-based continuum, the patient. Bundled payments provide the opportunity for providers and leaders to build and deliver on this clinical and financial promise.

Though mandatory bundles may be a thing of the past, voluntary bundled payment models signify the future of value-based care.

Voluntary bundled payment models remain front and center of healthcare reform as evidenced by the current administration’s longstanding support of voluntary models such as Bundled Payments for Care Improvement (BPCI) and Accountable Care Organizations (ACOs) – two initiatives in which providers can move to value-based care at the rate they desire. In fact, CMS highlighted its intent to increase the opportunities to participate in voluntary models, including voluntary episode-based and bundled payment models.

The recently proposed changes to the Comprehensive Care for Joint Replacement (CJR) model and cancellation of the mandatory Episode Payment Models (EPMs) by CMS signals that voluntary bundles are likely to move forward, and even accelerate, as CMS and CMMI further recognize their value and support their expansion in response to market demand. In fact, as one of the first and largest BPCI conveners for hospitals and health systems, we anticipate the new model’s announcement any day now and are fully committed to supporting our partners down the strongest possible path to program success.

naviHealth remains even more encouraged by the opportunity for all providers to engage in a program shown to reduce readmissions, streamline care delivery, lower overall costs of care and most importantly, improve outcomes for patients. Together with our hospital partners, we have generated over eight percent aggregate gross savings across a BPCI portfolio that includes 40 out of 48 unique episode groups. On average, that’s over $2,200 in gross savings per patient episode.

Given the demonstrated success of bundled payments in reducing healthcare spend and improving outcomes, CMS has every reason to continue testing bundled payment models. Further, bundled payment models help CMS to deliver on its promise of providing more opportunities for physicians to participate in MACRA-qualifying Advanced APMs. Physicians will have the opportunity to not only realize performance payments through the model, but also qualify as an Advanced APM practitioner who is eligible for MACRA bonus payments.

Advanced BPCI will likely qualify as an Advanced Alternative Payment Model (APM) under MACRA, creating an opportunity for these hospital-based providers to fulfill MACRA APM requirements. Without participation in bundled payments, these physicians will likely not be able to meet the APM thresholds established by MACRA. Voluntary bundles create a compelling physician alignment opportunity for health systems that are looking to establish better relationships with these high-value providers.

For those providers that were participants in mandatory bundles such as CJR or cardiac care, they will be well positioned to continue their bundle efforts and should develop a transition ‘playbook’ to effectively expand and scale their CJR or cardiac infrastructure.  One benefit of the upcoming BPCI model is that hospitals will be able to choose additional episode groups or clinical conditions that will be attractive for bundled payment participation. The key for hospitals in this program will be to take a data-driven approach in determining which episode groups to select, observing post-acute utilization patterns to evaluate attractiveness.

Providing key benefits to hospitals, physicians and patients, bundled payment models are a viable opportunity for providers to participate in value-based reimbursement through their demonstrated ability to achieve higher quality care at a lower cost. Whether mandatory or voluntary, we see the shift toward value-based care as a positive for American health care and urge providers to take part in its expansion.

 Author information: Brian Fuller is the Vice President for Value-Based Care at naviHealth

For more on voluntary bundled payments and BPCI, watch our recent webinar where we explored health system fundamentals that must be considered in preparation for bundled payment participation and review activities health system leaders should embrace to drive savings opportunities, optimize patient outcomes and lay the foundation for the continued adoption of value-based care, specifically BPCI.

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The statements contained in this entry are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this entry.

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