Inside CMS' Bundled Payments Pilot: Profitable Post-Acute Care Partnerships

Inside CMS' Bundled Payments Pilot:
Profitable Post-Acute Care Partnerships

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With participation in CMS' Bundled Payments for Care Improvement (BPCI) pilot at record levels—more than 500 healthcare organizations are currently testing four payment models with 48 clinical conditions— interest in payment bundles has never been greater.

Inside CMS' Bundled Payments Pilot: Profitable Post-Acute Care Partnerships examines opportunities presented by bundled or episodic payments, based on the experiences of naviHealth, a convener for CMS for Model 2 and Model 3 of the pilot.

Model 2 concerns itself with retrospective acute care hospital coupled with post-acute care episodes; Model 3 is limited to retrospective post-acute care only.

Pre-publication discount on Inside CMS' Bundled Payments Pilot: Profitable Post-Acute Care PartnershipsIn Inside CMS' Bundled Payments Pilot: Profitable Post-Acute Care Partnerships, Kelsey P. Mellard, vice president of partnership marketing and policy with naviHealth, describes aspects of her organization's model of coordinated, data-driven care that have 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.

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In this 25-page report, Ms. Mellard shares the benefits and potential cost savings of engaging post-acute providers in bundled payment initiatives, a venture most hospitals have yet to explore.

In particular, she shares how naviHealth identified high-performing skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTACs) for participation in its Post-Acute Care (PAC) network, as well as the dashboard and other tools used to evaluate efficiency, quality and other metrics for prospective network members.

Although participation in the CMS BPCI pilot is currently closed, naviHealth strategies for efficient and timely data collection across a bundled payment episode, including cultivation of relationships among pre- and post-acute providers across an episode community, are timely for healthcare organizations considering an episodic or bundled model for reimbursement.

The four payment models of the three-year CMS BPCI pilot include financial and performance accountability for episodes of care. CMS hopes to determine whether the models will lead to higher quality, more coordinated care at a lower cost to Medicare.

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