Over the last decade, the Center for Medicare and Medicaid Services (CMS) has created both mandatory and voluntary programs designed to move healthcare providers from fee-for-service payment models to those that are value-based. Some of the most well-known programs are bundled payments.
Bundled payments have proven challenging for providers to address, as oftentimes they are unsure where or how to start. The shift towards value-based programs like BPCI (voluntary bundled payment program) and CJR (mandatory bundled payment program) have become a dividing issue amongst healthcare executives as some doubt the programs will drive desired success. More often than not, forward-thinking and progressive providers are already positioning themselves for the future by putting into place the right processes and structures for success.
Common Challenges in Succeeding Under Bundled Payment Programs
The purpose of bundled payments is to promote high-quality care, and the system is meant to reward providers that care for patients during the entire care episode at a predetermined cost. Conversely, if a provider goes over the predetermined budget or target price, it is required to pay the difference back to CMS.
The challenge for providers is that bundled payments require more coordination that is tailored to individual patient preferences than traditional fee-for-service models. Scaling this type of care management is typically a new process that will require better reporting, communication, and engagement workflows. Additionally, many providers do not have consistent processes around communicating with patients prior to their arrival or after they have left the facility.
By capitating episode-based payments, providers across the care continuum must work more closely together to understand and act upon patient needs. From gathering patient outcomes information at the physician office to proactive rounds in a rehab facility, if processes are not efficient and systems don’t communicate with each other, there is a greater risk of poor patient outcomes and of losing money. So, the question is, how can healthcare providers realize success under bundled payments? The answer lies in creating efficient and consistent patient engagement programs.
Utilizing Patient Engagement Strategies to Maximize Bundled Payment Rewards
As with any value-based initiative, involving patients in their care is critical to success. This is especially true of bundled payments. Under most CJR and BPCI models, providers are accountable for the patient for the entire care episode, which can include up to 90-days post-discharge. To ensure success, patients should be engaged prior to their scheduled appointment, educated while in the facility, and contacted throughout their recovery.
With proactive engagement strategies such as pre-op education and post-op follow up, providers can identify and prevent potentially costly events such as an infection or a readmission. There are many engagement strategies that can help providers achieve bundled payment goals and KPIs. For example, programs like CJR require providers to collect patient-reported outcomes. To do this, providers can implement kiosks at physician offices or they can proactively reach out to patients via call or text to capture the information. Additionally, clinical follow-up calls or wearable fitness trackers can be used to monitor patients post-discharge and determine if patients are experiencing any issues.
To further engage patients in the hospital or post-acute healthcare facility, rounds are a great way to track progress and leverage best practices such as teach-back to help prepare patients for their transition home and recovery. The bottom line is that there are countless interaction points where providers can engage patients in their own care to lower costs, improve outcomes, and enhance experiences.
Achieving Success with Bundled Payments
Whether you are a believer in bundled payments or a vocal skeptic, putting the right processes and technologies in place to drive patient engagement is proving to have a positive impact. Several hospitals in the U.S. are already meeting bundled program KPIs (key performance indicators) such as reduced readmissions with effective patient engagement and scalable patient engagement processes are what can drive long-term success.
The hospitals leverage the patient information they have to deploy automated calls and text messages, cross-continuum care management, and point-of-care data collection. By using technology, the team is able to leverage one orthopedic care coordinator to manage the day-to-day workflow associated with all total hip and knee replacement patient episodes.
By implementing patient engagement processes that leverage technology for efficiency, providers are creating a better experience throughout the entire care episode, all while reducing the overall cost of care. It is evident that risk-based models are here to stay with the launch of new programs such are BPCI Advanced, which is set to go live this year. As CMS and commercial payers continue to leverage value-based payments, patient engagement will play a critical role in improving quality and driving financial success.
Photo: mathisworks, Getty Images
John Banks Powell
John Banks Powell is the Vice President of Post-Acute Strategy at CipherHealth. Powell spearheads CipherHealth’s post-acute and bundled payment initiatives by partnering with providers across the care continuum who leverage CipherHealth’s patient engagement and care coordination solutions to meet quality initiatives. Powell holds a BA from the University of North Carolina at Chapel Hill, and a Masters degree from the Fuqua School of Business at Duke University.