On the landscape of opportunity for hospitals to profit from bundled payments, the potential lies in post-acute care, advises Kelsey Mellard, vice president of Partnership Marketing and Policy with naviHealth.
Preoccupied with such urgencies as avoiding CMS readmissions penalties and adhering to meaningful use requirements, most hospitals haven't taken the time to examine potential cost savings from engaging post-acute providers in bundled payment initiatives, Mrs. Mellard explained during a May 2014 webinar on opportunities from bundled payments.
But recruiting high-performing skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals into its post-acute care (PAC) network has helped to drive down SNF, IRF and LTAC per member per month (PMPM) costs for naviHealth, which bills itself as a risk partner for health systems and health plans managing PAC utilization and spend.
naviHealth is also an awardee convener for model 2 and model 3 of the CMS Bundled Payments for Care Improvement (BPCI) pilot. Model 2 concerns itself with retrospective acute care hospital coupled with post-acute care episodes, while model 3 is restricted to care episodes involving retrospective post-acute care only.
While there are more than 300 healthcare organizations participating in the BPCI pilot, naviHealth is most engaged in model 2, whose bundled reimbursement rewards efficiency, communication, accountability, Ms. Mellard noted.
The naviHealth model of coordinated, data-driven care has helped to reduce its average post-acute care costs in the Medicare population to $53 per member per month (PMPM)— almost half the national average.
"We impact and work with the discharge planners to identify the most appropriate setting for our beneficiaries and the duration of the setting, and then manage that readmission risk and prevention program that follows."
To identify potential participants for its PAC network, naviHealth has created dashboards that evaluate efficiency, quality and other metrics such as volume obtained from CMS. They also consult with care managers for recommendations, then invite the post-acute care providers to a 'town hall meeting' with our hospital partners to provide an overview of the bundled payment program.
"It's been fun to see the level of excitement of how the business model is fundamentally changing. Everyone wants to be at the table, because they know that we are entering a risk-bearing phase of our business and within healthcare in general."
While CMS has closed the opportunity to sign up for bundled payments for the moment, the time is still ripe to engage with providers already participating, she said.
Overall, given the level of activity, conversation, and pending legislation associated with episodic-based reimbursement, the future for bundled payments looks bright, concluded Ms. Mellard.
Listen to an extended interview with Kelsey Mellard.