What We’re Watching: June 18, 2019

THERE’S A DEADLINE NEXT WEEK

The deadline for organizations to apply to participate in the Bundled Payments for Care Improvement (BPCI) Advanced model is June 24. The application does not force organizations into the system, but rather permits access to CMS data so that opportunity areas can be better assessed.

What we’re saying: Premier is recommending that its members consider BPCI Advanced for three primary reasons.

1. Bundled payments will likely become mandatory, so mastering is important
2. Success will only become more difficult
3. Many participating Premier members have seen significant financial returns from bundled payments

Premier’s Bundled Payment Collaborative members have consistently outperformed others in achieving performance-based payments.

WE HAVE COMMENTS

The second draft of the Trusted Exchange Framework and Common Agreement (TEFCA), the federal design to create a national “network of networks” through which patient data will be exchanged was released on April 19^th. TEFCA outlines principles, terms, and conditions to support the development of a Common Agreement among participating networks. Also released was a 4-year funding announcement for a non-profit Recognized Coordinating Entity (RCE) to manage the network.

What we’re saying: Premier has provided comments on this draft, recommending pilot testing, reducing provider burden and disclosing any fees that could be imposed on providers.

ACO STUDY TIME

Two studies have been published recently on ACOs:

1. An analysis of commercial ACOs in California found that:
   • ACOs achieved the lowest total cost of care compared to health maintenance organization (HMO) and preferred provider organization (PPO) members by 1.0% and 4.4% respectively
   • ACOs scored equally as well as HMOs on quality but higher than PPOs
   • The study noted that HMOs faced several drawbacks, including difficulty accessing medical specialists and excessive administrative oversight
2. Another study found that ACOs utilize home visits more frequently than non-ACOs. The authors speculate that the increased accountability and flexibility of the ACO model is a primary driver for the greater uptake of home-based care among these organizations.

What we’re saying: Commercial payers are driving providers to take on more risk for their patient populations through ACOs and other value-based care models because they know this is the path to better care quality and lower costs.

IN CASE YOU MISSED IT

• Premier Provides Comments on the 2nd Draft of the Trusted Exchange Framework and Common Agreement
• Three Strategies for Clinically Integrated Networks to Achieve Financial Success
• Capitalizing on Retail Pharmacy to Increase Revenue and Drive Outcomes
• As Trade War Spreads to Mexico, Companies Lose a Safe Harbor
• Clinical Decision Support: A Bright Future for Healthcare Delivery
• Premier Submits Comments to CMS for the Direct Contracting – Geographic Option

What We’re Watching is a weekly blog focused on the current events Premier is following and their relevance to the work of Premier and its members. Check out last week's update.