Provides a series of recommended capabilities that health systems need to ensure financial and organizational success
CHARLOTTE, N.C.— Premier Inc. (NASDAQ: PINC), a leading healthcare improvement company, today 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.
“Bundled payments can be a vital strategic tool for health systems that are looking to advance their value-based care capabilities,” said co-author Mark Hiller, Premier’s vice president of bundled payments services. “While accountable care organizations (ACOs) require an organization-wide mobilization and assumption of risk that many find daunting, bundled payments can be tested within a few services lines, and expanded gradually if successful. Bundled payments also can create incentives to bring in providers that are traditionally left out of ACO or primary-care based models, including specialists and post-acute care providers that have a major impact on both costs and quality.”
Entitled Ready, Risk, Reward: Keys to Success in Bundled Payments, the guide 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.
With membership spanning across more than 120 healthcare facilities, Premier’s Bundled Payments Collaborative is one of the largest collaboratives of healthcare provider systems in the U.S. focused on episode-based care. The Collaborative provides the opportunity for leading health systems to analyze and identify sophisticated claims analytics, share insights and knowledge, benchmark performance, and learn core capabilities, as well as leading and evolving practices from each other to reduce the learning curve and accelerate success in implementing effective bundled payment models. Supported in this way, approximately 63 percent of Premier Bundled Payments Collaborative participants received positive savings payments from Medicare, outperforming their peers by 35 percent.