February 7th, 2018 null Tag Home Health Care

Choosing the Right Partner for BPCI Advanced

by Christy Vitulli and Shannon Abbott

BPCI Advanced, the newest voluntary bundled-payment model from CMS, is here. The deadline to participate is March 12, 2018, and we’re here to help.

Amedisys can help BPCI Advanced Participants better leverage the home with high-quality care, industry-leading patient outcomes and a lower total cost of care. We’re eager to partner with qualified preferred providers and bring more value to your organization, our shared patients, CMS and the payors in our markets.

BPCI Advanced

CMS recently announced its new voluntary episode payment model, BPCI Advanced, which will “aim to align incentives among participating health care providers for reducing expenditures and improving quality of care for Medicare Beneficiaries." In this new program, CMS will target 29 inpatient Clinical Episodes and three outpatient Clinical Episodes and measure quality and total cost of care of all services provided. Acute Hospitals, Physician Groups and Conveners (e.g. risk manager) can qualify with CMS as Episode Initiators (risk bearer) in this program. 

In the model, CMS seeks to:

  • Establish a single, retrospective bundled payment and one risk track
  • Create a ninety-day Clinical Episode duration starting with the Anchor Stay (inpatient MS-DRG) or Anchor Procedure (outpatient HCPCS code)
  • Qualify participants for participating in Advanced Payment Models (APM)
  • Tie payment to performance on seven quality measures (including all-cause Hospital readmission and Advance Care Plan for all measures)
  • Establish target prices in advance of the first Performance Period of each Model Year
  • Reconcile semi-annually to determine if Participant is eligible to receive a payment from CMS, or is required to pay a repayment to CMS

Our hospital, physician and convener partners are actively evaluating how they can leverage best practices from current programs and expand their participation in these new programs.

Amedisys Results

The new BPCI Advanced bundles are familiar territory for Amedisys. Key themes across the targeted clinical episodes are stroke, acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), joint replacement, fractures, gastrointestinal issues, renal failure and urinary tract infections, among others.

Amedisys has specialty programs based on an interdisciplinary approach focused on reducing hospitalization rates and improving functional status to manage heart failure and COPD patients. Patients are taught empowerment methodology to ensure long-term results. ER diversion protocols are built into the programs to expedite treatment of exacerbations and prevent hospitalization.

High-risk heart failure patients who participated in the Amedisys program had a 5% lower 30-day re-hospitalization rate and an 8% lower 60-day hospitalization rate than patients who did not participate in the program, as shown in the outcomes from the Heart Failure Program that Amedisys released in February. Additionally, moderate-risk heart failure patients had approximately 4% lower 30-day re-hospitalization and 3% lower 60-day hospitalization rates than patients who did not participate in the program. EMR enabled, evidence-based proprietary protocols are in place nationally for bundles to ensure consistency and rapid detection of issues.

Amedisys Partnership Models

BPCI Advanced presents an opportunity to collaborate across the health care delivery system (physician, inpatient, outpatient, post-acute care, suppliers, technologies, etc.) and demonstrate the value proposition of our collective efforts. Many times, finding willing collaborators is half the battle. As we’ve shared in our prior messages, Amedisys believes that quality is the price to entry, outcomes should lead any comparative discussion, and we all know there’s a real opportunity to better leverage care in the home in the national healthcare movement towards value. 

We work best when we’re collaborating directly as a home health Preferred Provider, within well-defined strategic partnerships, and contemplating how we might share risk together. Amedisys Clinical Programs, operational engagement, bi-directional information exchange and dedicated resources can help BPCI Advanced Participants improve patient outcomes, achieve shared partnership goals and better manage total cost of care. 

Contact us today. Let’s talk about what we can do together.

Christy Vitulli is the SVP of Payor Relations & Network Innovation for Amedisys. For inquiries about your partnership with Amedisys, contact us at payorcontracting@amedisys.com.

Shannon Abbott is the VP for Clinical Programs and Innovation for Amedisys, where she oversees our specialty clinical programs.

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