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Transition to Value-Based Care - BPCI Advanced Overview ... · Health Payer Intelligence, ......
Transcript of Transition to Value-Based Care - BPCI Advanced Overview ... · Health Payer Intelligence, ......
2017 Remedy Partners, LLC. All Rights Reserved.©.
2017 Remedy Partners, LLC. All Rights Reserved.
Transition to Value-Based Care - BPCI Advanced Overview
Gene Huang & Mary Moscato
November 30th
2017 Remedy Partners, LLC. All Rights Reserved.©.
1. Who We Are
1. Our Mission
2. Remedy Partners Overview
2. The Transition to Value-Based Care (VBC)
1. Value-Based Care Landscape
2. Bundled Payments Overview – Model 2 and 3
3. Pricing - What is the financial incentive?
4. Strategy- What is the business development incentive?
3. Remedy’s Model 3 Program
1. Our Role and Services
2. Program to Date
4. Next Steps
1. BPCI Advanced Timeline
2. Getting Started
Agenda
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2017 Remedy Partners, LLC. All Rights Reserved.©.| |
Remedy Partners delivers technology and
services that enable payers and providers to
organize and finance a patient’s episode of care.
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2017 Remedy Partners, LLC. All Rights Reserved.©.
Remedy Partners is the largest Awardee Convener in the BPCI program.
Remedy Partners at a Glance
Sources: Volume and program size data as of July 2017 reconciliation, 2013Q4-2016Q4,
all Model 2 and Model 3 episodes, with retro drops removed. Demographic data as of
July 2017 reconciliation, 2016Q1-2016Q4, all Model 2 and Model 3 data.
5,400Unique physicians
initiating episodes
1,300Post-acute sites at
which physician
groups initiate
episodes
730Hospitals at which physician groups initiate episodes
410Skilled nursing
facilities initiating episodes
110Physician groups
initiating episodes
340,000Cumulative BPCI episodes managed to-date
$8.4BCumulative medical spend managed to-date
45States in which we manage episodes
1,000Unique EHR Integrations
18MMonthly EHR Transactions
Who We Are
4
2017 Remedy Partners, LLC. All Rights Reserved.©.
Some AJAS members already working with Remedy and with BPCI
Remedy Partners at a Glance – AJAS Overlay
2AJAS Members in
Model 3 with
Remedy Partners
2AJAS Members in
Model 3 separately
5+Members already
evaluating BPCI Advanced
6+Facilities working
with Remedy Model 2 partners
Who We Are
5
• Red = AJAS Members
• Blue = Remedy Model 3
2017 Remedy Partners, LLC. All Rights Reserved.©.
CMS is Dedicated to Innovation Commercial Payers are Following
Payment Reform is Here to Stay
Leading providers and payers have been increasingly shifting away from fee-
for-service structures and embracing the transition to value-based care through
the adoption of Alternative Payment Models (APMs).
On September 20th, the Centers for Medicare
and Medicaid Services (CMS) published a
Request for Information
MA membership moving to VBC
Payments tied to membership in VBC models:
Source: Humana press release, http://press.humana.com/press-release/current-releases/fullwell-enters-new-value-based-agreement-humana-colorado
Advisory Board, https://www.advisory.com/daily-briefing/2015/01/29/20-health-systems-insurers-agree
Health Payer Intelligence, https://healthpayerintelligence.com/news/unitedhealthcare-cut-costs-through-value-based-care-programs
2018
2018
2020
75%
75%
Current spend tied to VBC models
$65B
“Strengthening Medicare and Medicaid will
require health-care providers to compete for
patients in a free and dynamic market, creating
incentives to increase quality and reduce costs”
CMS’ announcement promotes:
Consumer empowerment and transparency
Increased and continuous competition
Use of waivers to enable meaningful innovation
The Transition to Value-Based Care
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2017 Remedy Partners, LLC. All Rights Reserved.©.
The Transition to Value-Based Care
Bundled payments significantly
improve care and cost
outcomes and can be integrated
into other VBC models to drive
greater overall efficiencies.
Bundled Payments Drive Success
in Concert with Other VBC Models
Home Health Value-Based
Program
Skilled NursingFacility
Value-Based Program
Comprehensive Care for Joint Replacement
(CJR)
Value Modifier
Bundled Payment for Care
Improvement (BPCI) Initiative
Next Generation
ACO
Merit-Based Incentive Payment System
ComprehensiveESRD Care
Medicare Shared Savings Program
Comprehensive Primary
Care Plus(CPC+)
Hospital Readmissions
Reduction Program
Oncology Care Model
Million Hearts Cardiovascular Disease Risk
Reduction Model
Independence at Home
Demonstration
IMPROVED PATIENT
CARE AND COST
OUTCOMES
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2017 Remedy Partners, LLC. All Rights Reserved.©.
Current BPCI Program
• Four BPCI models offered through the initiative, with more than 75% of participants selecting Model 2 or 3
➢ Model 2 episodes are initiated by an inpatient admission to an acute care hospital and include related care
covered under Part A and Part B within 30, 60 or 90 days following discharge from hospital
➢ Model 3 episodes include post-acute care following an inpatient acute care hospital stay and all related care
covered under Medicare Part A and Part B within 30, 60 or 90 days following initiation of post-acute services
• Targeted 181 MS-DRGs rolled into 48 Bundles (24 surgical and 24 medical conditions)
• CMS Awardee Conveners lower the barrier to entry for provider participation by bearing financial risk and
operationalizing program administration
The Transition to Value-Based Care
Continued voluntary
participation
• Bipartisan support for voluntary bundles
• CMS recently scaled back mandatory
CJR and Cardiac programs
Advanced APM status
under MACRA
• BPCI Providers eligible for 5% MACRA
bonus
• Dependent upon certain percentage of
Medicare Patients going through an APM
• New advanced APM designation for BPCI
Quality-based
performance measures
• Complications and mortality statistics
• Patient satisfaction scores
• Patient reported outcome metrics
(where applicable)
Anticipated Enhancements to BPCI Advanced
The Evolution of Bundled Payment Programs Launched in 2013, the BPCI program is the largest demonstration program in
CMS’s history covering $8 - 10B in Medicare fee-for-service payments.
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Skilled Nursing Challenges
Remedy Partners understands that Skilled Nursing Facilities (SNFs) are
facing a complex market where patient volume and margins are decreasing.
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• Referral streams are decreasing as partners become more selective in which
SNFs to send their patients after discharge.
• SNFs face greater competition for referrals from Home Health Agencies (HHAs)
as hospitals push patients to lower cost settings.
Narrowing referral networks
• Downward trend in SNF reimbursement rates combined with lower patient census
have eroded SNF margins.
Declining margins
• Providers are facing pressure from hospital partners to shorten LOS as much as
possible to reduce episode costs while maintaining quality.
Downward trend in Length of Stay (LOS)
2017 Remedy Partners, LLC. All Rights Reserved.©.
Increasing Growth and Performance with BPCI
BPCI allows SNFs to gain a competitive advantage in their markets.
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Provides an opportunity to increase margins and revenue • SNFs can take control of the
bundle and assume risk in
Model 3, reaping the financial
rewards for effectively
managing patients across the
episode.
Allows SNFs to gain access to valuable CMS data without cost• SNFs gain access to their
historical data in the
Opportunity Analysis phase of
BPCI.
• Remedy Partners analyzes this
information at no cost to
determine the financial upside
for partners.
Positions SNFs for long term success in the post-acute care market • CMS is committed to rewarding
providers that accelerate value
based care. Model 3 SNFs gain
a competitive advantage for
increasing hospital referrals,
Medicare business and census
development.
2017 Remedy Partners, LLC. All Rights Reserved.©.
Our Model 3 Expertise
Our expert team utilizes its national expertise and commitment to the SNF
market to support provider operations.
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• Remedy Partners is the largest Awardee Convener in the Model 3
program, supporting 400 SNFs.
• Our scale allows us to finance, structure and deploy bundle
payment programs for facilities of varying sizes and geographies
with no impact on cash flow.
Largest Model 3 Awardee Convener
• Our Model 3 project managers utilize data insights to craft
specialized programs to improve provider performance based on
demand.
• These programs focus on driving improved care, lowering costs
and improving patient satisfaction.
Specialized Program Development
• Our account management team focuses on driving operational
success with our SNF partners.
• AMs hold monthly business reviews and provide best practices for
managing BPCI operations and meaningful data insights that
promote clinical, operational and financial success.
Dedicated Account Management (AM) Team
2017 Remedy Partners, LLC. All Rights Reserved.©.
Remedy Model 3 Outcomes
With our solution, providers have been able to improve quality of care while
driving down costs.
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1CMS 2016Q4 Reconciliation results for Q22015-Q42016; due to low volume includes only SNF systems with 3 or more SNFs live in 2018Q1; savings rate calculated as net
payment reconciliation amount as a percentage of target spend, not including CMS 3% discount; Includes all true-up results; some quarters not fully reconciled2CMS Monthly claims, compares 2009-2012 baseline period to 2016 live bundles
Range of Program Saving Rates
by Remedy SNF System1
16.6%Reduction in
90-day episodes with a
readmission2
-10%
-5%
0%
5%
10%
15%
20%
25%
30%
2017 Remedy Partners, LLC. All Rights Reserved.©.
Remedy Model 3 Outcomes
We work closely with partners to maintain high program and bundle retention
in order to achieve positive financial returns.
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1CMS 2016Q4 Reconciliation results for Q22015-Q42016; positive financial results defined as combined positive net payment reconciliation amount (NPRA) Q22015-Q42016.
Includes all true-up results; some quarters not fully reconciled; due to low volume, includes only SNF systems with three or more SNFs live in 2018Q1.2Comparison of BPID and Bundle selection counts between CMS Q42015 Analytic File and CMS Q22017 Analytic File; includes all Model 3 provider types
92%Remedy SNF systems with
positive financial results1
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Providers Retained Bundles Retained
Remedy Participants Non-Remedy Participants
BPCI Program Retention (2015Q4-2017Q2)2
2017 Remedy Partners, LLC. All Rights Reserved.©.
Hebrew SeniorLife –
Experiences of a Remedy
Client
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2017 Remedy Partners, LLC. All Rights Reserved.©.
Hebrew SeniorLife
• The largest provider of senior care in the Boston metropolitan area
• A non-profit, non-sectarian, integrated, eight-site system of health care, housing, research and teaching
• Devoted to innovative gerontology and geriatric research, senior health care, long-term nursing home care, and Greater Boston senior housing communities that improve the lives of older adults
• Serves people of all faiths and backgrounds
• An affiliate of Harvard Medical School
Housing/ Independent Living
Assisted Living
Skilled Nursing
Long Term Acute Care
Long Term Care
Outpatient Medicine
Outpatient Rehab
Day Health
Home Health
OP Hospice
Research
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Satter House
Hebrew Rehabilitation
Center
Center Communities of Brookline (3)
Fireman CommunityOrchard Cove
NewBridge on the Charles
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HSL Did Apply –
• Contracted with outside Convener to assist with data tracking from
CMS claims.
• HSL’s IT /Fiscal departments teamed up for improved readiness of
tracking costs by patients and conditions
• HSL’s choice of bundles will demonstrate opportunity to reduce
Medicare expenses
• HSL can manage costs after SNF discharge due to ownership of
continuum (i.e., Home Care and Outpatient Therapy care)
• Added Care Transitions Coordinator
2017 Remedy Partners, LLC. All Rights Reserved.©.
Selected Episodes of Care for July 1, 2015
Roslindale
• 15 selected (only favorable)
• In-service nursing, rehab,
physician, case management
and home care teams
• Created a color-coded
spreadsheet of ‘favorable
‘DRGs by location and
Episode LOS
• 4 additional DRGs added in
July for October 1, 2015 ‘go
live’
NBOC
• 18 selected (only favorable)
• In-service nursing, rehab,
physician, case management,
and home care teams
• Created a color-coded
spreadsheet of ‘favorable’
DRGs by location and
Episode LOS
• 5 additional DRGs added in
July for October 1, 2015 ‘go
live’
2017 Remedy Partners, LLC. All Rights Reserved.©.
Project Manager, Care Transitions and
Accountable Care
2017 Remedy Partners, LLC. All Rights Reserved.©.25
Top 3 Performing Bundles: 2016 Q4
BUNDLES EPISODES NPRA NPRA %
Complex non-cervical spinal fusion 2 $40,976 49%Major joint replacement of the lower extremity with
hip fracture split51 $36,852 5%
Sepsis 6 $33,166 19%
Top 3 Performing Bundles: Program To Date
BUNDLES EPISODES NPRA NPRA %
Major joint replacement of the lower
extremity222 $208,580 6%
Spinal fusion (non-cervical) 37 $176,592 22%
Major bowel procedure 15 $120,686 30%
2017 Remedy Partners, LLC. All Rights Reserved.©.
Patient ID Accuracy
On average, each Remedy Model 3 patient identified in Episode Connect
generates $500 in additional savings (NPRA, not winsorized).
2016 Q4 RECONCILIATION | PATIENT ID 26
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60 Day Bundles
2016 Q4 vs Adjusted Historic
82 Episodes
15.4% decrease in SNF Covered
Days
3.9% percentage point decrease in
Episodes
with a readmission
2017 Remedy Partners, LLC. All Rights Reserved.©.
CMS Requires indication of interest
Remedy’s process starts with Non-Binding Letter of Intent (LOI)
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• LOI allows Remedy to include all of your facilities in our application to CMS
for BPCI Advanced
• LOI gives CMS permission to share your claims data and pricing for bundles
in your facility with Remedy for analysis on your behalf
• Non-binding agreement allows you to exit at any time, with no penalties, no
fees, no commitments
• LOI will be followed by Participant Agreement should you want to continue in
the program with Remedy
2017 Remedy Partners, LLC. All Rights Reserved.©.
Success Starts with Selecting the Right Bundles
Our unrivaled expertise in bundle selection methodology for SNFs
guarantees providers are primed for success.
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Before CMS delivers your data, we start with Medicare’s national dataset of all providers (LDS).
Preliminary Data Review
Early analysis identifies savings, mitigates risk and accounts for your unique strategic, operational and
clinical needs.
Program Opportunity Analysis
This provides an invaluable head start on implementing your program before receiving CMS
pricing data.
Operational Readiness Assessment
Remedy Partners will evaluate BPCI bundles against your historical performance to choose the ideal
bundles set for your organization.
Final Bundle Selection & Submission
2017 Remedy Partners, LLC. All Rights Reserved.©.
Remedy Partner Implementation Workflow
Our comprehensive implementation approach ensures SNF providers are
ready to execute on their bundles.
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BPCI Program
Structure
Education and
Configuration
Care Redesign
Implementation
Program
Management
We finalize bundle
selection, program
goals and identify
BPCI champions so
your team is ready to
execute on your
bundles.
During this stage, we
educate your staff and
key stakeholders on
BPCI processes
through Remedy
University and
configure Episode
Connect.
Your team has direct
access to our Model 3
team who will finalize
your patient
identification program
and provide support for
your clinical,
operational, financial
efforts.
We work with your
team to implement care
redesign programs to
ensure optimal length
of stay and effective
discharge programs with
Next Site of Care (NSOC)
are established.
2017 Remedy Partners, LLC. All Rights Reserved.©.
Gene Huang
VP of Business Development
Contact Information
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Mcknight’s Article by Gene HuangThree Reasons Your SNF Should Sign Up for CMS’s BPCI Program