Learning from Bundled Payments Pioneers

Designing a successful bundled payments initiative means drawing wisdom from those who are already succeeding—and not forgetting what makes your hospital unique.

DJ: To be successful in a bundled payments scenario, a hospital or health system needs to reduce its spend per episode, and be particularly efficient in the post-acute phase. Under the mandatory CJR program, hospitals also need to have high quality and patient satisfaction.

In the voluntary BPCI program, success factors have proven similar across our clients. Successful hospitals are tapping both historical claims data and current operational data to track and manage patients across an episode of care. More importantly, they're getting this data in the hands of surgeons. Surgeons who have incentives through the program are better able to connect the dots and understand how their practices influence patient outcomes and postacute utilization, how those outcomes influence the hospital's success, and then how the hospital's success impacts their own incentives within the bundle.

DJ: As an analytics company, our models are always rooted in empirical data. We are able to project for every hospital in the country how they would perform in the CMS' CJR program, because we apply the CJR rules to their historical performance data. That is only the starting point, though, as organizational factors such as care process standardization, physician engagement and the ability to work with postacute providers play a role in their success.

DJ:Our goal is to bring 80% to the table, in terms of proven processes, best practices and successes, and determine the other 20% of design based upon hospital-unique factors. For example, physician incentive strategies vary depending on a hospital's competitive position in their local market—a fully employed staff of surgeons will think about incentives very differently than multiple, independent groups of surgeons.

Hospitals also differ on post-acute strategies in terms of the way they need to optimize home health, outpatient physical therapy and skilled nursing. These characteristics are important to a bundled program's design because it needs to be implemented by the system in a way that the stakeholders—physicians, executives, nursing staff, post-acute providers—all buy into it.

DJ: They can be. Providers that are close in proximity to a market where patients are part of a bundled program can be impacted, in that they may provide care within that patient's episode. Secondly, CMS has been foreshadowing these types of programs for years, and there is reasonable chance that Medicare bundled payments will continue to expand. We are also seeing more commercial insurers beginning to implement bundled payment strategies of their own. Providers need to position themselves now for success in the future.

ABOUT TRUVEN HEALTH: We're dedicated to delivering the answers our clients need to improve healthcare quality and access, and reduce costs. Our unmatched data assets, technology, analytic expertise, and market-wide perspective have served the healthcare industry for more than 30 years. For more information, please visit truvenhealth.com.