Bundled Payments for Care Improvement - Advanced January 15, 2018 - PowerPoint PPT Presentation

Bundled Payments for Care Improvement - Advanced January 15, 2018

Agenda for today 1 Welcome & Introductions 2 Strategies for the early phases of BPCI Advanced 3 Review of the opportunity – Why should you be interested? 4 Overview of BPCI-A 5 A look at the CV data 6 Your first steps & actions 7 Q&A 2

01 WELCOME & INTRODUCTIONS 3

Dave Terry Keely Macmillan CEO & Co-Founder GM BPCI Advanced Archway Health Archway Health Joel Sauer Ginger Biesbrock Vice President Vice President 4 MedAxiom MedAxiom

THE SOLUTION EDUCATION DATA READINESS & TOOLS & OPTIMIZATION SOLUTIONS The MedAxiom & Archway Health partnership is intended to make design and implementation of bundled payment programs as simple as possible for heart programs. The team combines the expertise of CV consultants, proven healthcare operators, big data analysts, and technology entrepreneurs. 5

Archway Overview Company Background • 100% focused on bundled payments – its all we do • Built comprehensive, one-stop-shop bundled payment platform • Founded in 2014 with offices in Boston and NY • Backed by athenahealth & Coverys (medical malpractice insurance company) Experienced Team • Our team has been active in BPCI since its inception in 2011 • Active in all of the CMS bundled payment programs – BPCI, CJR, OCM, BPCI – A Convener in the BPCI program Trusted Partner • Working with dozens of clients & hundreds of providers across the country • Expanding beyond CMS into the commercial and self-insured employer markets Real Results • All of our partner hospitals & physicians are earning significant savings – Up to $12 million annually per hospital – Up $100,000 per physician in PGPs 6

02 STRATEGIES FOR THE EARLY PHASES OF BPCI-A 7

Timeline for BPCI-A rollout 24 pages, not a 30- minute process!

12 Components of BPCI Advanced Application, Due March 12 th 30+ Narrative questions Each component has several narrative questions: 1. Organization Information , including CEHRT attestation, participant list, and executive summary of application 2. Practitioner Engagement – including plan for consent, retention, and adherence for care redesign 3. Care Improvement – plan for care redesign care processes in evidence-based medicine, beneficiary/caregiver engagement, quality and care coordination, including readiness assessment 4. NPRA Sharing –experience in gainsharing and P4P initiatives, and proposed methodology for BPCI Advanced gainsharing 5. Quality Improvement – including experience in improvement interventions and plan for quality improvement in BPCI A 9

12 Components of BPCI Advanced Application, Due March 12 th 30+ Narrative questions (Cont…) Each component has several narrative questions: 6. Quality Assurance – Approach to ensure clinical appropriateness, including Sanctions, Investigations, Probations, or Corrective Action Plans 7. Beneficiary Protections –plan for beneficiary protection, education, engagement 8. Financial Arrangements- planned gainsharing arrangements and funds flow mechanism 9. Organizational Capabilities and Readiness – 10. Partnerships – business relationships 11. Data Request & Attestation 12. Certification 10

MedAxiom homepage

This isn’t an uncomplicated process

We’re trying to make it easy! Oh and with no commitments either! 13

Our Bundled Payment Process Phase IV: Phase I: Phase II: Phase III: Continuous Pre-Program Program Program Performance Activities Design Management Improvement • Preliminary • Governance & • Ongoing • Best Practice Opportunity leadership Performance Sharing Tracking – Archway Assessment structure • Performance • Strategic • Select 2-3 High Analytics Coaching & Evaluation Priority • Real Time Patient Training Tracking – Archway • Application & DRA Opportunity Areas • Clinical & Process Submission • Care Management Carelink Innovations • Detailed Pricing Process Design • Financial • New Payor & Analysis • Preferred Reconciliation Employer • Bundle Selection Provider Network Management Contracts • Contract Development • Funds Distribution • New Provider submission • Provider • Ongoing CMS Recruiting Gainsharing & Reporting • Bundle Adds & Collaboration Drops Agreements 14

Why we encourage you to apply • March 12, 2018 deadline • Non-binding commitment to CMS • Allows you to see your data (all of it) • Get to see the Target Price o So can quantify estimated opportunity • Provides several months to make final participation determination o August 2018

03 REVIEW OF THE OPPORTUNITY – WHY SHOULD YOU BE INTERESTED? 16

Example: Variation in CHF w/MCC spending by state MS-DRG 291 State avg post acute care spend for CHF w/MCC ranges from $10,000 to $17,500 Anchor IP HHA IRF LTCH HOPD Readmissions SNF 17

Example: Variation in CHF w/MCC spending by NJ Hospital MS-DRG 291 Avg post acute care spend for CHF w/MCC among NJ hospitals ranges from $15,600 to $27,500 18

What is a Bundled Payment? In a bundled payment model, a single provider is responsible for managing all aspects of care during a discrete episode. Provider as “Conductor” Bundle Definition • “Trigger event” starts episode (specific DRG or procedure) • Defined end date - 90-day episode length • Providers are given a bundle-specific Target Price • All clinically relevant costs are included in the Target Price • Providers share in savings below Target Price • Retrospective payment model 19

How is Additional Revenue Earned? Example calculation for Congestive Heart Failure Providers earn additional revenue when actual costs are less than the target price (savings are in addition to traditional professional service billing) 0 5,000 10,000 15,000 20,000 25,000 Target 23,000 Price Avg Actual 20,000 Costs Inpatient Anchor Readmissions PAC Facility (LTACH, SNF, IRF) Home Health $3,000 savings Part B (Prof & drugs) Hospital OP Other (OP, DME) per case kept by specialist 20

National Average CHF Bundle Opportuni ty Cardiologists could earn an additional $3.8k per CHF bundle Anchor IP HHA Avg wage-adjusted CHF Total Bundle cost = $19.1 k • IRF Avg wage-adjusted CHF Post Acute Care (PAC) cost = $ 12.8 k (67% • LTCH of total) HOPD Readmissions Cardiologists could earn an additional $1,300 - $3,800 per CHF • SNF bundle by reducing PAC utilization by 10 - 30% – 38% of CHF bundles include a readmission; Avg readmissions per CHF bundle = $5.1k – Cardiologists could earn an additional $1k per CHF bundle by cutting readmissions by 20% 21

Advanced-APM: Eligibility Thresholds Increase Overtime Physicians must have minimum % volume under risk arrangement A-APM Track: Revenue and Patient Count Thresholds 75% 75% 80% Payments through Advanced APMs 70% Patients in Advanced APMs 60% 50% 50% 50% 50% 50% 35% 35% 40% 25% 25% 30% 20% 20% 20% 10% 0% 2019 2020 2021 2022 2023 2024+ Payment Year Performance Year 2017 2018 2019 2020 2021 2022+ Medicare-only Option Medicare or All-Payer Options Medicare threshold calculation: Can include Medicare Advantage; Medicare Part B payments for bundle patients/ denominator depends on participating Total Medicare Part B payments - or - providers Medicare bundle patients / Total Medicare patients

04 OVERVIEW OF BPCI-A 23

BPCI Advanced Model – Key takeaways Voluntary program with two anticipated start dates: 10/1/2018 and • 1/1/2020 Non binding application due March 12 th for first start date Ø 29 inpatient bundles and 3 outpatient bundles • More sophisticated target pricing methodology • Qualifies as an Advanced Alternative Payment Model (APM) Under • MACRA Episode Initiators can be acute hospitals or Physician Group Practices • (PGPs) Quality performance will adjust incentive payments • While still non-binding, Application for BPCI Advanced is more robust • than recent open window periods 24

Bundle Definitions • 90-day post discharge period for all bundles • Retrospective Reconciliation: FFS payments are billed and paid for as usual, and the total FFS payment for the bundle is retrospectively reconciled against a pre- determined target price o Semi-annual reconciliation Patients Excluded: Patients Included : Beneficiaries covered under Medicare Advantage or United Mine Workers or with Medicare as a all Medicare FFS beneficiaries secondary payers; ESRD eligible beneficiaries; beneficiaries who die during the Anchor Stay or Anchor Procedure 25