Premier, a healthcare improvement company, released a new best practice guide to help providers make strategic decisions for continued financial and organizational success within current and emerging bundled payment models.
The guide entitled Ready, Risk, Reward: Keys to Success in Bundled Payments, summarizes lessons learned from Premier’s experience with health systems participating in bundled payments, and recommends strategies for optimizing performance as health systems increasingly move into these models with commercial, employer and government payers.
“Bundled payments require very specific clinical, technical and administrative capabilities across the continuum in order to properly assess opportunities and manage risk,” said report co-author Beth Ireton, Premier’s principal of bundled payments services. “These capabilities are particularly critical as providers contemplate new models like Bundled Payments for Care Improvement (BPCI) Advanced. In our experience, success starts with data analytics to choose the best episodes with the greatest savings opportunities, including those that have the widest variation in terms of cost and quality, those with significant overutilization of post-acute care, and high-volume, high dollar procedures that rely on expensive resources.”
Beyond these capabilities, the guide recommends additional best-practice steps to enhance performance and prepare for risk-based contracting, including:
- Strong leadership and governance structures that secure physician/clinical champions and support for the bundled payment program through the design of aligned goals and shared resources to facilitate high-performance within an episode.
- Program and episode design knowledge to successfully define the bundle and determine the target price, negotiate or manage the overall stop gain/stop loss cap, and understand the nuances of reconciliation rules and repayment practices.
- The ability to measure, monitor, and evaluate bundle performance, as well as forecast for the future, using detailed claims and eligibility data across the continuum (inpatient, professional visits, and post-acute care).
- The ability to assess and redesign care across the episode (i.e., find and close care gaps) and to execute continuous improvement processes to achieve both low-cost and high-quality outcomes using care management and patient navigators that plan for pre-hospitalization care all the way through rehabilitation.
- A narrowed network of high-quality, low-cost post-acute care providers that are willing to agree upon and adopt practice tools and processes that standardize patient experience and promote quality outcomes.
These recommended strategies for optimizing cost and quality performance are based on Premier’s experience as a bundled payments convener within the BPCI initiative organized by the Centers for Medicare & Medicaid Services (CMS), as well as lessons learned from members of the Premier Bundled Payments Collaborative.
