Archive for the ‘Bundled Payments’ Category

Infographic: Maternity Episodes of Care

January 16th, 2017 by Melanie Matthews

Maternity Episodes of CareThe cost of maternity care varies significantly by payer (commercial or Medicaid), by type of birth (vaginal or cesarean section), and by setting (hospital or birth center). Too often, women are not experiencing optimal outcomes in maternity care despite the significant resources spent, according to a new infographic by the Health Care Payment Learning & Action Network.

The infographic examines how an episode of care could be applied to maternity care—from an episode timeline for prenatal through postpartum care; episode parameters; operational considerations; and maternity care design elements.

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) has awarded $3 million to 51 specialty medical practices as part of a shared savings arrangement through the company's Episodes of Care (EOC) program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. As the largest commercial payor of Episodes of Care in the United States, Horizon BCBSNJ recently reported far lower hospital readmission rates and improved clinical outcomes for members in its EOC practices versus non-EOC practices in 2014.

During Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship, a March 31, 2016 webinar, available for replay, Lili Brillstein, director of the Horizon EOC program, shares the details behind the health plan's EOC program, from the episodes they have bundled to the goals and results from the program.

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2016 Healthcare Headlines: MACRA Monopolizes News Until Election Shake-Up

December 26th, 2016 by Patricia Donovan
top 2016 news stories

The unexpected election of Donald J. Trump to the U.S. presidency threatened some healthcare initiatives from the Obama administration, including the Affordable Care Act.

There was only one thing capable of distracting the healthcare industry in 2016 from MACRA's imminent rollout: the election of Donald J. Trump to the presidency of the United States.

Nevertheless, the majority of the last twelve months was spent on healthcare business as usual—the business of transitioning to value-based models of care delivery and reimbursement.

Here are the headlines that dominated the news feeds of healthcare executives in 2016:

New CMS 'Accountable Health Communities' Model Aims to Improve Patients' Health by Addressing Social Needs

January 2016: In a first-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs, the HHS appropriated $157 million in funding to bridge clinical care with social services.

The new pilot will test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical healthcare-related visits.

Medicare Shares 6 Core Principles for 21 New 'Next Generation ACOs'

January 2016: The Centers for Medicare & Medicaid Services (CMS) made waves when it launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model.

Providers Slow to Adopt Population Health, Value-Based Models of Care: Study

February 2016: Most healthcare providers continue to lag in implementing population health management despite broad agreement it will be important for future market success, according to a national study by healthcare strategy consultancy Numerof & Associates. The study synthesized survey responses from more than 300 executives and in-depth interviews with over 100 key decision-makers across U.S. healthcare delivery organizations. It provided the first in-depth, national look at the pace of transition from fee-for-service to models based on fixed payments linked to outcomes.

Horizon BCBSNJ 'Episodes of Care' Program Pays $3 Million in Shared Savings to Specialty Medical Practice

February 2016: Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) announced that it paid out approximately $3 million to 51 specialty medical practices as part of shared savings generated through the company’s innovative Episodes of Care (EOC) Program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. The EOC model, also known as bundled payments, is one in which specialists manage the full spectrum of care related to a specific procedure, disease diagnosis or health event—such as a joint replacement or pregnancy.

Bundled Payments Improve Care for Medicare Joint Replacement Patients: NYU Langone Study

March 2016: Implementing bundled payments for total joint replacements resulted in year-over-year improvements in quality of care and patient outcomes while reducing overall costs, according to a new three-year study from NYU Langone Medical Center. The three-year pilot at the medical center reported reductions in patient length-of-stay and readmission rates.

CMS to Test New SNF Payment Model to Curb Readmissions, Foster Multidisciplinary Care

March 2016: The Centers for Medicare & Medicaid Services (CMS) today announced it would test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents. This next phase of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents seeks to reduce avoidable hospitalizations among beneficiaries eligible for Medicare and/or Medicaid by providing new payments to practitioners for engagement in multidisciplinary care planning activities.

Proposed MACRA Rule Would Streamline Medicare Value-Based Payment Models

May 2016: In issuing a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians, the Department of Health & Human Services took the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

May 2016: As they digested the HHS's momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations began assembling arsenals of educational tools to de-mystify MACRA. The federal government's first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

CMS Releases MACRA Final Rule; Creates Two Pathways for Clinician Value-Based Payments

October 2016: The Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the administration’s progress in reforming how the healthcare system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care.

ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 2016: If U.S. President-elect Donald J. Trump delivers on his campaign promises, the 'repeal and replacement' of the Affordable Care Act (ACA) should be an early priority for the nation's chief executive-in-waiting. That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

Trump Taps Orthopedic Surgeon, Medicaid Architect to Helm U.S. Healthcare Posts, Determine ACA Fate

November 2016: Calling his nominees "the dream team that will transform our healthcare system for the benefit of all Americans," President-elect Donald J. Trump announced his plan to nominate Chairman of the House Budget Committee Congressman Tom Price, M.D. (GA-06) as secretary of the U.S. Department of Health and Human Services (HHS) and Seema Verma as administrator of the Centers for Medicare and Medicaid Services (CMS).

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Infographic: Tracking Patient Status for Bundled Payments

August 10th, 2016 by Melanie Matthews

The Centers for Medicare and Medicaid Services is targeting the wide variations in quality and cost of hip and knee replacements (lower extremity joint replacement [LEJR]) through its LEJR bundled payment program launched in April, according to a new infographic by Caradigm.

The infographic examines these quality and cost variations as well as the sites of care where patients typically recover from these surgeries.

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign A desire to position itself at the forefront of healthcare payment reform and be a catalyst for clinical redesign are two factors driving Brooks Rehabilitation's participation in Model 3 of CMS's Bundled Payments for Care Improvement (BPCI) initiative.

Today, having completed more than 1,000 bundled episodes for total hip replacements, total knee replacements and hip fractures, Brooks has reduced cost by 19 percent per episode, lowered readmissions to about 15 percent across its 60-day time frame, registered a patient satisfaction level of 94 percent and documented significant functional improvement.

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign examines the four domains of success of Brooks' Complete Care program supporting the organization's bundled payment clinical outcomes and financial results.

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Guest Post: 6 Ways Predictive Analytics Will Move Healthcare Forward in 2016

June 28th, 2016 by Anand Shroff, co-founder and chief technology and product officer, Health Fidelity

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Identifying at-risk patient populations is one way to use predictive analytics to generate rapid returns.

In non-healthcare sectors like retail and manufacturing, 'predictive analytics' was arguably the top buzz phrase of 2015. Respected industry analyst Gartner even included predictive analytics in its 'Top 10 Strategic Technology Trends' roundup. Predictive analytics have become increasingly important in the healthcare industry, too, as the volume of electronic data grows.

But healthcare organizations have grappled with how to access, analyze and apply their data. Many lack the advanced automated capabilities needed to extract meaning from complex, unstructured data sets from multiple sources. However, it’s crucial to find a way, since the stakes are incredibly high: A McKinsey & Company study estimated that the industry could extract $300 billion in value annually from big data and drive overall healthcare expenditures down by 8 percent.

The key to extracting maximum value from healthcare data sets is to use predictive analytics and cloud-based technologies. By analyzing current and historical data and using the findings to predict future events and trends, healthcare enterprises such as accountable care organizations (ACOs) and others can address the cost-quality equation that is so essential to successful operations in an outcomes-based environment.

The pay-for-performance ecosystem ACOs and other healthcare organizations operate in today demands new strategies to handle bundled payments and population health management challenges, and predictive analytics are tailor-made to produce the insights they need. Using predictive analytics to assess current data sheds new light on the following key metrics:

  • The relationships between cost, quality and patient outcomes;
  • Clinical best practices that drive optimal patient outcomes; and
  • Individual and population-level health risks.
  • By submitting current metrics to predictive analytics, healthcare organizations will gain incredibly valuable insights into how various factors intersect to affect outcomes and which issues they need to address first to drive improvements and value. As they respond to changes in payment models in 2016 and beyond, healthcare organizations will also use predictive analytics to refine their strategies by:

    • Gaining insights into risk factors and how to optimize risk management;
    • Identifying the practices, performers and results that affect organizational performance; and
    • Assessing the impact of ACO reimbursement and bundled payment strategies.
    • Taken together, these are the six ways predictive analytics will move healthcare forward in 2016. By leveraging the power of predictive analytics, healthcare organizations will be able to clearly identify the factors that drive clinical quality and operational expenses. And by applying this information, they can predict and manage clinical and financial performance with greater accuracy. Moreover, they’ll have the opportunity to drive continuous improvement in practices and processes, which will minimize costs while maximizing care quality going forward.

      Healthcare organizations that want to put predictive analytics to work for their operations should consider a two-part strategy that focuses on simple, high-value initiatives first. They’ll need to create an infrastructure that allows them to secure quick wins and then address more complex projects—for example, focusing on revenue improvement by using predictive analytics to proactively manage risk can pay tangible, substantial dividends in the short term.

      Identifying at-risk patient populations in terms of the 30-day readmission window is another way to use predictive analytics to generate rapid returns. Once healthcare organizations have the right processes and practices in place, they can branch out into more complex initiatives like analyzing value-based payment models such as the ACO, episode-based care and patient-centered medical homes. The ability to use discrete and unstructured clinical, financial and operational data to improve performance is the key to success.

      Organizations that embrace predictive analytics in 2016 and beyond will have a key competitive advantage: They will have finally unlocked the value of their data. Predictive analytics have transformed many business sectors in 2015, and 2016 is shaping up to be the breakthrough year for predictive analytics in healthcare, driving better value and outcomes. That’s good news for healthcare organizations and patients alike.

      Anand Shroff

      Anand Shroff, co-founder and chief technology and product officer of Health Fidelity.


      About the Author: Anand Shroff is a co-founder and chief technology and product officer of Health Fidelity. He is responsible for the company’s product strategy and execution and marketing initiatives. He has championed the cause of enterprise performance improvement by promoting electronic capture, exchange and analysis of healthcare data. Prior to founding Health Fidelity, Anand was vice president of EHR and HIE products at Optum. Anand has an MBA from the Haas School of Business at the University of California, Berkeley and an MS in Computer Science from the University of California, Santa Barbara. Anand has an undergraduate degree in Computer Engineering from the University of Mumbai. Connect with Anand on LinkedIn and on Twitter.

      HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Hospitals and Value-Based Care

June 22nd, 2016 by Melanie Matthews

While healthcare organizations broadly support the goals of value-based reimbursement, there are mixed results in achieving those goals, according to a new survey by HealthCatalyst. Many hospitals have embraced value-based initiatives such as accountable care organizations and bundled payments that reward higher quality care while penalizing low quality but few of those surveyed are faring well against Medicare's goal of tying half its $597 billion in annual payments to value-based care.

A new infographic by HealthCatalyst examines the likelihood of healthcare organizations meeting CMS' value-based reimbursement goal, the percent of healthcare organizations that are currently engaged in risk-based contracts and the importance of analytics in value-based success.

The New Physician Quality Reporting: Positioning Your Practice for MACRA's Merit-Based Incentive Payment System,A new CMS proposed rule would combine several of its existing physician value-based reimbursement programs, including the meaningful use EHR Incentive Program, the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VBM). This proposal is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the Sustainable Growth Rate (SGR) formula for physician reimbursement. Under this current proposal, physicians will be reimbursed by Medicare under either the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs) starting in January 2017. As this reimbursement shift by CMS moves forward, physician practices are re-examining how they report on physician quality. Most practices will opt for the MIPS program based on their current risk-contracting strategies.

During The New Physician Quality Reporting: Positioning Your Practice for MACRA's Merit-Based Incentive Payment System, a 45-minute webinar on July 14th, Eric Levin, director of strategic services, McKesson, will provide a brief MACRA overview and outline where practices need to focus for the remainder of 2016 to avoid reimbursement penalties in 2017 based on the proposed rule.

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Horizon Episodes of Care Program Prototype for Value-Based Specialty Care and Reimbursement

April 21st, 2016 by Patricia Donovan

Horizon BCBS-NJ's Episodes of Care program engages specialists across a suite of nine episodes.

Imagine a value-based healthcare payment model in which the sole financial hazard to specialist providers is the risk of amassing additional revenue.

Further, envision a scenario in which these specialists are invited to design their payment program, from the model's intent to key quality metrics.

Those are some highlights of Horizon Blue Cross Blue Shield of New Jersey's Episodes of Care (EOC) program, a value-based model designed to focus specialists on the provision of quality- and value-based care across nine separate episodes, from joint replacement to hysterectomy to oncology.

Hailed as a national leader in advancing the episodes model as a prototype for value-based specialty care, Horizon is careful to distinguish its EOC program from a bundled payment initiative, for two key reasons.

"First, our EOC program is a quality-based program; it's not only about the payment or payment structure," explained Lili Brillstein, director of the Horizon Episodes of Care program during a recent webinar, Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship.

Secondly, bundled payments typically refer to a prospective model in which a bundled amount of money is paid to a provider or group of providers in advance of services being delivered, while Horizon's retrospective model pays providers after services have been provided.

The upside-only nature of Horizon's retrospective model contributes to the program's collaborative nature, Ms. Brillstein added. "If the metrics are met, savings are shared. If the metrics are not met, we’re not punishing our partners."

There is other evidence of collaboration and of Horizon's desire to see the providers succeed in the EOC program. One example is the payor's use of case mix-adjusted budgets at the practice level rather than the prevalent member-specific risk-adjusted budgets. "This budgeting allows Horizon to create an opportunity for providers to move the needle [on a metric], and benefit from that. The opportunity for cost savings and shared savings also is dramatically improved."

Another case in point is Horizon's invitation to prospective providers to talk through the episode's construct, intent and design prior to its launch.

Horizon's engagement of providers in the EOC program has "changed the spirit of the relationships between the payor and the provider," Ms. Brillstein noted. "It’s like nothing I’ve ever seen before. Our provider partners have become our ambassadors for the program."

Select EOC results presented during the webinar indicated that outcomes are better for EOC partners—in the area of reduced readmissions, for example—than they are for physicians not in the EOC program.

Horizon expects to launch at least three more episodes in 2016, including a Crohn’s Disease episode that will take into account behavioral health services for those members. While the payor fully expects to move to a prospective model, it believes its current EOC model is preparing them for that eventuality, softening the transition from fee for service to prospective payments.

"[That transition] doesn’t just happen. You don’t sign the paper, and suddenly know what to do. It is an evolutionary transformative process," concluded Ms. Brillstein.

Click here to listen to an interview with Lili Brillstein: Horizon BCBSNJ Episodes of Care: No-Risk Retrospective Model Paves Way for Value-Based Migration

Infographic: The Payor/Provider Perspective on the Switch to Value-Based Care

March 28th, 2016 by Melanie Matthews

Healthcare decision-makers are not ready for the switch to value-based healthcare, according to a new infographic by Xerox.

The infographic highlights results from a recent Xerox study on the payor and provider perspective on value-based healthcare.

Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) has awarded $3 million to 51 specialty medical practices as part of a shared savings arrangement through the company's Episodes of Care (EOC) program. The doctors, in five different specialty areas, earned the payments by achieving quality, cost efficiency and patient satisfaction goals in 2014 while treating more than 8,000 Horizon BCBSNJ members. As the largest commercial payor of Episodes of Care in the United States, Horizon BCBSNJ recently reported far lower hospital readmission rates and improved clinical outcomes for members in its EOC practices versus non-EOC practices in 2014.

During Episodes of Care: Improving Clinical Outcomes and Reducing Total Cost of Care Through a Collaborative Payor-Provider Relationship, a March 31, 2016 webinar at 1:30 p.m. Eastern, Lili Brillstein, director of the Horizon EOC program, will share the details behind the health plan's EOC program, from the episodes they have bundled to the goals and results from the program.

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Guest Post: Delivering Value-Based Healthcare Starts at the Top

January 7th, 2016 by Nicholas Christiano, National Managing Partner, Healthcare, Tatum

The healthcare industry has long been characterized by change and evolution. Yet, new requirements introduced by the Affordable Care Act (ACA), as well as changing demands and expectations among patients, have created new pressures for today’s healthcare organizations. Healthcare providers that fail to address this new reality and meet the call for more value-based healthcare that focuses on the patient will struggle to remain sustainable in this changing world.

So, what can healthcare management do to prepare their organizations to deliver more customer-centric care? Although a recent study found that the vast majority of healthcare CEOs plan to improve their ability to innovate, change technology investments and better manage data, very few have made significant headway in these areas. As with any large-scale change, the move to customer-centric healthcare needs to start at the top. To ensure an effective transition, C-level executives, whether the CEO or chief medical officer (CMO), must take the lead to get their teams on board and ensure they can create a sustainable model for the future.

A New Approach to Patient Care

Today’s patients have greater choice in the care they receive, meaning that organizations that don’t provide a positive experience for their patients will struggle to compete. The onus to improve falls on the CEO and CMO, who must revamp the typical patient experience of waiting a long time, only to spend five to seven minutes with the physician. Healthcare leaders can improve the process by making the operation more like a concierge service—scheduling appointments at literal points in time to minimize waiting, enabling patients to enter their information only once and treating patients as valued customers. They should also strive to offer more flexibility by way of extended hours, home visits and telehealth programs that enable patients to have a remote, video-based conversation with their physician.

In addition to optimizing the patient experience, healthcare leaders must also change their cost structures. Rather than the typical process of determining prices behind closed doors and putting a margin on it, costs need to come down, be determined by performance and quality of service and be delivered with greater transparency. More and more, the industry is shifting to a value-based operating model. One such example is the accountable care organization (ACO) model, whereby healthcare providers join together to deliver a payment and care delivery approach that ties provider reimbursements to quality metrics, while driving down costs for an assigned patient population.

The ACO approach links payment to quality improvements that can reduce costs for patients; data from the U.S. Centers for Medicare & Medicaid Services found that the ACO model has led to savings of $417 million since the program began in 2012. As the model continues to evolve, healthcare organizations will be managing a particular portion of the population whom they see regularly. When patients are part of a healthcare organization and receive frequent care, fewer patients will need emergency room service, resulting in lower costs. The industry is increasingly moving towards value-based operating models, but as with any change, implementing the associated customer-centric practices may be easier said than done.

Best Practices to Deliver Customer-Centric Care

To ensure their organizations remain competitive and sustainable in the face of unprecedented change across the healthcare industry, the CEO and CMO must implement the strategies that can lead to positive transformation. Though large-scale changes don’t happen overnight and inevitably will be met with some resistance, healthcare leaders should consider the following best practices to deliver a customer-centric approach:

  1. Meet patients where they are: Today’s healthcare consumers increasingly expect the same level of service from their healthcare providers that they receive in other areas of life and business. Healthcare leaders must spearhead the process changes that meet this demand, by providing greater flexibility, extended hours, home visits and telehealth.
  2. Set the tone for employees: To implement effective change management and overcome employee resistance, CEOs and CMOs must provide strong guidance throughout. Working with other C-suite executives to identify transformation needs, communicate these changes, introduce tools that can facilitate the transition and explain how each employee can contribute to delivering customer-centric care is essential.
  3. Revamp cost structures: To be successful, CEOs and CMOs must deliver on two key priorities: keeping patients healthy and providing service at reasonable costs. This entails designing a fundamentally different operating model and driving down costs for activities that do not provide value – all while offering higher-quality care to their target population.
  4. Seek outside help when needed: Healthcare leaders might not always have the internal senior-level capacity and capability needed to accelerate change. Leveraging the help of an executive talent provider to ensure the organizations have the support and expertise to deliver a more customer-centric patient experience can make all the difference.

Meeting Demand for a New Level of Care

As the ACA has given more people greater access to healthcare—and more options in how they receive that care—healthcare leaders must rethink their current processes to deliver high quality care. If patients are unhappy, they can always switch to another provider. In this age of empowered patients and increased competition between providers, the CEO and CMO must communicate a transformative vision throughout their organizations. This starts with having qualified leadership at the top to guide these changes, the right technology to facilitate the processes and the best team to deliver on this goal. With these factors in place, healthcare organizations can deliver the customer-centric care necessary for success in today’s healthcare climate.


Nick Christiano

About the Author: Nick Christiano is responsible for the overall execution of the National Healthcare Practice for Tatum, a Randstad company. The Healthcare Practice provides executive leadership solutions to healthcare provider organizations, heath plans, private-equity backed bio-tech firms and affiliated organizations where subject matter expertise is critical to a successful client engagement. Christiano is recognized as a leader in the pursuit of optimum patient care, productivity, efficiencies, cost management and navigating new challenges in the healthcare field. He has an M.B.A. in MIS/Finance from the John Hagan School of Business – Iona College and a B.S. with a dual major in Computer Science/Electrical Engineering from N.Y.I.T.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

2015 Healthcare Headlines: Top Stories Trace Route to Value-Based Reimbursement and Care

December 28th, 2015 by Patricia Donovan

Month by month, the industry's top stories confirmed that value-based innovations and collaborations are here to stay.

A look back at the year's top healthcare stories captures the industry's commitment to enhance the quality and efficiency of care delivered while reining in cost. Nearly all of HIN's most-read stories fell into one of two categories: announcements of new value-based models or pilots, or results from existing quality-focused initiatives.

Here are the stories that captured the attention of healthcare executives in 2015:

HHS Announces Timetable, Goals for Medicare Value-Based Reimbursement
Medicare kicks off 2015 with the rollout of an ambitious multi-year agenda for a shift to value-based reimbursement and alternative payment models.

Cigna Collaborative Care Reduced Avoidable ER Visits by 16 Percent
The February release of Cigna’s second-year results from a collaborative care initiative with Granite Healthcare Network documented significant progress in improved health and affordability.

2015 Hospital Market Will Hasten Transition to Value-Based Payment Business Model
The early 2015 economic outlook for the hospital industry continued to favor the largest, most geographically diverse health systems in the market, according to this January 2015 forecast from BDC Advisors.

Medicare Discharge Planning Proposed Rule: More Focus on Patient Preferences, Follow-Up Care and Communication
CMS proposed in October a revision of discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs.

Senate's Repeal of Medicare Sustainable Growth Rate Strengthens Move Toward Value-Based Physician Reimbursement
April 2015 saw the U.S. Senate's landmark repeal of the Medicare Physician Payment Reform Bill, otherwise known as the Sustainable Growth Rate (SGR), a mechanism used to calculate Medicare payments to physicians.

One-Fifth to Launch 'Next Generation ACO' in 2015
Twenty percent of healthcare organizations plan to participate in CMS’s new ‘Next Generation ACO' model in the coming year, according to 2015 Accountable Care Organization metrics compiled in May.

8 Wellmark Medicare ACOs Saved $17 Million in 2014, Boosted Quality by 8%
September saw the release of Wellmark Blue Cross and Blue Shield’s 2014 Accountable Care Organization (ACO) Shared Savings model data, in which eight participating ACOs improved their overall quality scores by 8 percent and saved more than $17 million during 2014.

CMS Launches New ACO Dialysis Model
CMS announced in October its Comprehensive ESRD Care (CEC) Model, designed specifically for beneficiaries with ESRD and built on lessons learned from other models and programs with ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program.

Final Rule for Joint Replacement Bundled Payments Favors Composite Quality Score
In November, CMS finalized its Comprehensive Care for Joint Replacement (CJR) model, set to begin on April 1, 2016, which will hold hospitals accountable for the quality of care they deliver to Medicare fee-for-service beneficiaries for hip and knee replacements and/or other major leg procedures from surgery through recovery.

Geisinger Pilots Patient Experience 'Warranty' for Select Surgeries
The Pennsylvania health system generated headlines in November with the launch of its innovative ProvenExperience™ warranty, a program that keeps the patient experience front and center by offering refunds to patients undergoing select surgical procedures whose expectations weren't met based on kindness and compassion.

To stay abreast of the latest healthcare headlines in 2016, subscribe free to HIN's Healthcare Business Weekly Update.

5 Reasons for Post-Acute Care to Participate in Bundled Payments

September 1st, 2015 by Patricia Donovan

Bundled payment participation put Brooks Rehabilitation on the forefront of healthcare payment reform.


Having completed more than 1,000 bundled episodes for total hip replacements, total knee replacements and hip fractures, Brooks Rehabilitation has achieved significant savings through Model 3 of the CMS Bundled Payments for Care Improvement (BPCI) Model 3. Here, Debbie Reber, MHS, OTR, vice president of clinical services for Brooks Rehabilitation, explains Brooks' rationale for participating in episode-based payment models.

Why would post-acute care be responsible for bundled payments, as opposed to the acute care provider? When CMS's original bundles came out, it looked as though they would all be driven by acute care providers. At the time that Brooks jumped in, there was not a lot of information on what our opportunity would be or how this model was going to look. To explain our rationale for jumping into bundled payments, Brooks decided it was going to participate in order to be on the forefront of learning more about payment reform. We wanted to look at how post-acute care providers could help make some of the healthcare policy changes related to the future of healthcare reimbursement.

Second, we also really wanted to serve as a catalyst for a business to begin working better as a system of care. With all of our different divisions and the way our care settings are spread over the various counties that we serve, sometimes it was difficult for us to work as a united, seamless system. We thought moving to bundled payments offered a great opportunity for us to work better as a system of care, improve our care transitions, and improve our continuum.

Third, the other huge opportunity with bundled payment is the chance to experiment with clinical redesign. We approached bundled payments as having a blank slate: we could redesign the care to look and feel however we wanted it to be. If we could do things all over again, what were the tasks or gaps or cracks in our clinical care that we could really improve upon?

Fourth, we knew we wanted to have a strong voice regarding future policy and payment reform changes. And finally, we wanted to show that, in addition to key providers, Brooks was sophisticated enough to take risk and play a primary role with that continuum of care.

Source: Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign

post-acute care bundled payments

Bundled Payments for Post-Acute Care: Profiting from Alternative Payments and Clinical Redesign shares the inside details of Brooks' Complete Care program and the resulting, significant savings Brooks achieved through CMS's BPCI Model 3, which is limited to retrospective post-acute care (PAC) for select diagnosis-related groups (DRGs).