A New Season To Drive Transformation Through Bundled Payments

September 29, 2017

A New Season To Drive Transformation Through Bundled Payments

by | Sep 29, 2017 | Grow Article |

Navvis Grow Article By: Kristi Short, Navvis Senior Vice President of Post-Acute Care and Sheila Fusé, Navvis Vice President & Senior Executive of Policy & Payment


Fall has officially arrived, and without an announcement from the Centers for Medicare & Medicaid Services (CMS) on the re-opening of the voluntary Bundled Payments for Care Improvement (BPCI) program.

While the industry awaits the expected announcement, many healthcare organizations are already considering how bundled payments will advance their financial health, growth opportunities, and strategies regarding physician alignment and care management.

Many are asking:

  1. Should we participate in BPCI when it reopens? And if so, which episodes make sense from an economic and strategic perspective?
  2. What do we need to do to be successful?

From our perspective at Navvis, the reopening of BPCI presents a new window of opportunity that healthcare leaders should not overlook.

From our perspective, healthcare executives should not be asking whether to participate; rather, they should be asking how they can leverage participation in BPCI to achieve economic and patient care goals while growing market share.

By diving into BPCI models, they can unlock significant value, and not solely from the gain sharing achieved through incremental bundled payment contracts.

Why Bundled Payments Matter

At their core, BPCI bundled payments create economic opportunities through strong performance in value-based contracts. More than that, bundled payments expose previously hidden weak links in patient care across the continuum. The right bundled payment strategy will drive stronger clinical outcomes, higher patient satisfaction, and lower costs of care.

Healthcare organizations that successfully manage bundled payment contracts will inherently expose and mitigate care coordination issues across the continuum, and help identify and address areas that are lacking in physician/care team alignment and engagement.

A strong bundled payment management model can help reign in disparate post-acute care costs, and expose poor quality providers. A focus on decreasing the variability of post-discharge pays off on multiple fronts, most specifically in improved quality and cost efficiency – two key success metrics in all types of value-based payment models.

Creating New Value and Unlocking Growth Opportunities

BPCI is best viewed within a larger universe. Focusing a narrow lens solely on bundled payment gain sharing misses bigger opportunities to align investments in analytics, patient tracking, physician alignment, and care pathways with a range of high-value healthcare payment models.

BPCI contracts represent a manageable way to build infrastructure, including the people, processes, and technology necessary to be successful in executing these contracts and engaging specialists. For many, BPCI serves as a port of entry in advancing toward a longer-term value-based delivery that includes commercial bundled payment contracts, and complements accountable care organization (ACO) strategies.

For any healthcare organization, successfully engaging in BPCI models will support a range of quality initiatives, most significantly Alternative Payment Models (APMs) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Successful engagement will also address out-of-control post-acute spend, improve hospital throughput, reduce readmissions and other unnecessary utilization, and ensure the provision of high-quality, cost-efficient care.

Getting Ready

Below, we present three practical steps to help you prepare now for the expected opening of BPCI models:

  1. Quantify economic opportunity and risk. Consider your current 90-day episode costs (focus on those with material volume), how these costs compare to national and/or local benchmarks, and identify excess costs along the continuum that could be eliminated through improved bundled payment care models and reduced variations.
  2. Assess the performance of your post-acute providers, including their degree of alignment and accountability. Determine your opportunity to improve performance in bundled payments by building a high-performing, accountable, contractually aligned post-acute care network.
  3. Engage physician leadership to optimize support/buy-in for future bundled payment participation. Engagement, alignment, and motivation are critical in driving change in clinical practices that ensure program success.

More to Come, From Navvis

Stop back soon, as we add more insights to our Navvis Grow article series. We’ll cover more BPCI developments, the CMS announcement when it arrives, and a wider range of insights involving growth strategies and ways to unlock new value for your organization.