Snapshot of CMS Bundled Payment Care Initiative

Tuesday, July 1st, 2014
This post was written by Patricia Donovan

From both transparency and best processes standpoints across the entire nation, post-acute care presents an incredible opportunity to streamline not only the staging but also the quality of care provided to Medicare beneficiaries, notes Kelsey Mellard, vice president of partnership marketing and policy for naviHealth, a convener for Models 2 and 3 of the CMS Bundled Payment Care Initiative (BPCI).

Bundled payments touch four opportunities to engage providers in various settings. Model 1 is for retrospective acute care episodes, which focus only on the acute hospital stay. Model 2, which is where naviHealth is most engaged to date, is retrospective acute care hospitals plus the post-acute care. Our goal is building alignment—not only financial alignment but also quality alignment across both the hospital and the post-acute care settings, regardless of whether it’s a home health agency, a skilled nursing facility (SNF), an inpatient rehabilitation facility (IRF) or a long-term care hospital (LTCH). With model 3, we just have the episode focused on the retrospective post-acute care only. Finally, model 4 is for acute care hospital stays only.

Within these four models to date, we’ve seen over 300 organizations sign up and be active in phase 2, which means that they are in the risk-bearing phase. They are financially bearing risks for an episode based on the target sites that CMS has generated. Primarily, the 300 are split between Model 2 and Model 3. The first model, retrospective acute, is most active in the New Jersey market, model 4 has a few hospitals that are scattered throughout the country.

NaviHealth went live focusing on model 2 for a couple of reasons in January 2014, with 11 hospitals in five states. We will expand again in October and will further expand starting January 1, 2015, given the time frame that CMS has allowed us to continue our expansion and our partnerships as an awardee convener.

CMS is keenly focused on the variation of post-acute care, based on the most recent Institute of Medicine (IOM) report stating that if regional variation in post-acute care did not exist, we would see Medicare spend variations fall by 73 percent.

From a transparency standpoint and from a best processes standpoint across the entire nation, post-acute care has an incredible opportunity to streamline not only the staging, but also the quality of care provided to Medicare beneficiaries.

Excerpted from: Bundled Payments: Opportunities in Effective Retrospective Acute and Post Acute Care Bundles

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