This October the first cohorts of Awardees in Models 2, 3 and 4 for the Bundled Payments for Care Improvement (BCPI) will begin their last year of the 5-year program.

This July, marks the start of the 2nd year of 5 for mandatory for Comprehensive Joint Replacement (CJR) bundles. Amid the swirl of uncertainty on the timing and terms of bundled payment expansion, participants are asking what it takes to ensure bundled payment programs are sustainable.

My perspective is that regardless of whether CMS makes the next round of bundle payments voluntary or mandatory, bundled payments are here to stay. Why? Because the bundled payment approach is a superior model for creating and delivering value in health care. Payments are tied outcomes that matter most to patients and it covers all the services and facilities that are involved in treating the full episode of care. Bundled payments also align incentives for health systems to create integrated, multidisciplinary care teams and form partnerships that leverage services and technologies to support value-based care.

Because bundled payments are an effective method to reducing costs and improving care coordination, necessarily the target price for bundles will go down over time. Those health systems that fail to keep up will see their market share move to competitors that have figured it out. To stay in the game, bundled payment providers need Data, Data, Data.
1. Data to Design Post-Acute Care (PAC) networks and care pathways
a. What are my utilization patterns relative to competitors and best practices?
b. Where do I stand relative to historical and regional targets?
c. Why do I have variations in practice patterns?
d. How do I align incentives with network partners to improve quality and reduce costs?
2. Data to Monitor bundled payment patients as they move across care settings
a. What is the source of on-going variation?
b. Where are my patients by care setting?
c. Why are certain patients cost outliers?
d. How is my bundle performance relative to target?
3. Data to Manage proactively high risk patients
a. Who are the high risk patients?
b. What clinical pathway will achieve the best results?
c. Where can I intervene to head off problems before they happen?
CMS and other payers give providers access to the claims data for their bundled payment patients on either a monthly or quarterly cycle. Effective use of this data provides valuable insights into what is working and what is not. However, relying solely on one’s own bundled payment claims to manage a program leaves significant blind spots:
1. BCPI/CJR claims are just for my patients – it is kind of like a Yelp review that only show you restaurants you have already visited. You need a comprehensive market view to know where you stand relative to competitors.
2. BCPI/CJR claims are old – in the best of circumstances, claims data will lag actual events by four to six months. More typically, it will lag by six to nine months. Steering with a rear view mirror is hard. You need real-time data across partners and care settings to run an effective learning loop.
3. BCPI/CJR claims are history – while improving the timeliness of claims data is always a good thing, it is not enough to just know what has already gone wrong. To make bundles sustainable, both historical and real-time data must be translated into predictive analytics that help match patients to appropriate care pathways and anticipate adverse events before they happen.

Sustainable bundled payment programs require continuous improvement which is only possible with effective use of timely data.

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