Prioritizing Episodes of Care – Expanding a Bundled Payment Program

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By using historic data to model the underlying, fee-for-service activity in the context of episodes of care, Aver’s Episode Snapshot tool helps payers “see” fee-for-service activity through a bundled payment lens. Our initial bundle opportunity analysis identifies the episodes of care with the greatest opportunities to improve quality and reduce cost, showing payers where to begin their program. But what about payers looking to expand on their existing bundled payment program?

As we mentioned in our last post, Aver’s bundle opportunity analysis illustrates the greatest opportunities to improve quality and reduce cost through bundled payments. Our analysis either validates or invalidates a client’s initial hypotheses about which episodes of care to begin with, the providers they should contract with, and suggests additional episode opportunities for payers to consider.

Aver - Episode Cost

The bundle opportunity analysis helps payers see what their initial bundled payment program might look like and allows them to start looking beyond those first few episodes. Aver’s clients are very forward-thinking and often want to start planning version 2.0 of their bundled payment program even before executing version 1.0. They are concerned that once they pick the “lowest hanging fruit” the second set of episodes may be a much heavier lift. While this is true, to a certain extent, Aver has identified the following ways to incrementally scale a payer’s bundled payment program to facilitate organic growth.

One logical place to start growing a bundled payment program is to approach providers who are already participating in existing programs about bundling additional episodes of care. If a payer begins with hip and knee replacements and revisions, they could talk to participating orthopedic surgery groups about expanding to include shoulder replacements and/or revisions or lumbar laminectomy procedures.

 

"One logical place to start growing a bundled payment program is to approach providers who are already participating in existing programs about bundling additional episodes of care."

 

Another tactic is to explore the BPCI bundles in which local providers are participating. Data outlining provider participation in BPCI is publicly available, and Aver can analyze a payer’s data to display provider performance on specific BPCI bundles. Coronary artery bypass graft (CABG) surgery, and percutaneous coronary intervention (PCI) episodes tend to have high participation among providers, so if a payer hasn’t explored those bundles yet, that may be a logical next step. If a provider is already receiving a bundled payment for those episodes from one payer (Medicare), they will likely be open to a similar program from another payer.

Finally, payers and providers who are more advanced in value-based contracting might consider bundling payments for chronic conditions and behavioral health. Several Aver clients are exploring diabetes care as a starting chronic condition bundle. In particular, this may make sense for payers with a fairly high concentration of accountable care organizations (ACOs) in their market. Typically, ACOs have already modified care pathways to improve outcomes and quality at the population health level and tend to focus on improving care for chronic conditions like diabetes. While a healthcare organization participating in Medicare’s ACO programs may not wish to expand to a private payer ACO contract, they might consider taking on more risk via bundled payments for chronic conditions.

When exploring opportunities for expanding a bundled payment program, we still keep in mind the criteria we use in targeting episodes for launching a program – episode cost, quality, volume, variation, ease of execution, and relatively high degree of modifiable spend. This helps to grow the program in a more organic way, ensuring payers and participating providers can use lessons learned from the first round of episodes to inform their work on expanding episodes.

In addition, while the episodes of care identified for expanding a program might be a bit more complex than the episodes with which a payer launches their program, we’ve found that the momentum created at program launch helps drive expansion. In addition, when payers outsource the management of their bundled payment program to Aver, they get a team of bundled payment experts, engineers, and analysts whose sole focus is ensuring their value-based payment program succeeds.

By using historic data to model the underlying, fee-for-service activity in the context of episodes of care, Aver’s Episode Snapshot tool helps payers “see” fee-for-service activity through a bundled payment lens. Our bundle opportunity analysis identifies the episodes of care with the greatest opportunities to improve quality and reduce cost, showing payers where to begin and how to expand their program. The next step is identifying the right providers to participate – we’ll tackle that topic next.


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ALEX ANTHONY
Customer Delivery Team
Aver, Inc

 
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JOY TU
Customer Delivery Team
Aver, Inc


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