BUNDLED PAYMENTS: PAST, PRESENT FUTURETHE NATIONAL BUNDLED PAYMENT SUMMIT: JUNE 17, 2014Presenter: Steve Wiggins, Managing Director, Essex Woodlands
“WHEN THE RULES CHANGE, THE GAME CHANGES”Bundled Payments: Past Present Future
Bundled Payments: Past Present Future
WE ARE ON THE RIGHT TRACKDistributed by Remedy Partners to Name Here , Proprietary and ConfidentialBundled Payments: Past Present Future
A LOOK AT THREE MODELS: FROM PAST TO PRESENTo Commercial Episode Program in the Mid 1990’so Episode Based Insurance Program in Early 2000’so Medicare’s Bundled Payment ProgramBundled Payments: Past Present Future
OXFORD SPECIALTY MANAGEMENT:COMMERCIAL EPISODE PROGRAM (1995-1998)o Launched by commercial payer with over 2m memberso Patients entered episodes AT DIAGNOSISo 10 Specialties. 86 High Level Episodeso Home Grown Episode Definitionso Concept of a Parts List – Building Blocks of each Episodeo One or two measures of Outcomes for each episodeProviders loved it!Cost per-episode declined 17%Bundled Payments: Past Present Future
WHAT WE LEARNEDo Providers needed a plug and play model. Episode based payments are complicated!o Lack of Open Source episode definitions created a never ending debateo Physicians were better General Contractors than Hospitalso Exposed wide variations in Cost Levels –even in the same community!o Benefit differentials would be needed to steer patients to episode teamso Patient Identification improved Overall Care Management:o Provider calls for eligibility and pre-certificationo Claims Codeso Customer ServicesBundled payments clearly worked.Bundled Payments: Past Present Future
o Online Exchange for FFS and Episode Bundleso Episode Based Health Insurance Planso Member Risk!o Home Grown Episode Definitions: 204 Medical and 178 Procedural Episodeso Episode was triggered at Diagnosis: Claims, Customer Service Call or Request for Auth.o Communication Events Drove Member Successo Grew to 50,000 membersBundled Payments: Past Present Future
HealthMarket: Episode Based Insurance Product Featureso Benefit Levels of a Standard PPO, with Spending Limits on 100 Episodes of Care.o Savings Account for Routine and Preventive Serviceso SMARTFUND Spending Accounts for Individual Episodes of Careo A portion of unused SmartFunds deposited in Member Health Reimbursement Accounto Price and Quality “Transparency” –disclosure of PPO fee schedule and quality scoreso Elimination of managed care requirementswww.remedypartners.comDistributed by Remedy Partners to Name Here , Proprietary and Confidential9
HEALTHMARKET LESSONS LEARNEDo Patients Are Remarkably Thriftyo Episode Allowances Are A Powerful Way to Lower Health Spendingo Rewarding Patients Improved Retentiono The Killer App: Member Allowances and Provider BundlesBundled Payments: Past Present Future
MEDICARE BPCI PROGRAMo Episode triggered by admission to Hospitalo Broadly defined episodes with performance and period risko Mostly a Retrospective Programo Concept of Awardees and Awardee Convenerso Limited Beneficiary Benefit IncentivesBundled Payments: Past Present Future
FEW PATIENTS ARE EQUIPPED TO NAVIGATETHE MODERN HEALTH CARE SYSTEMESPECIALLY SENIORSBundled Payments: Past Present Future
WE KNOW HEALTH CARE IS A TEAM SPORTBundled Payments: Past Present Future
UNPRECEDENTED RELEASE OF HISTORIC CLAIMS DATABundled Payments: Past Present Future
BPCI TO-DO LISTo Patient Identificationo Patient Assessment, risk stratification and On-boardingo Discharge Process Re-engineeringo Care Planso Contracting and Gain Sharingo Technology Toolso SNF monitoring and controlo In-Home patient/caregiver engagemento Risk Mitigationo Quality Metrics and Collectiono StaffingBundled Payments: Past Present Future
THOUGHTS ON RISKo Randomnesso Small No Size Matterso Pooling and Cross Collateralizationo Reserve Buildingo Quarterly Reconciliations - Annual True-upBundled Payments: Past Present Future
SIMULATION RESULTSBundled Payments: Past Present Future
SIMULATION RESULTSBundled Payments: Past Present Future
BPCI DESIGN CHALLENGESo No Control Over Payments – Need to Move toProspective Paymento Medicare Payment Policies Increase Costso No Medical Necessity Controlso Beneficiary Assignment RulesBundled Payments: Past Present Future
TrendingACO OverlapRe‐PricingRandomnessHHRGsBundled Payments: Past Present Future
COMPARISONS: ACOs BUNDLED PAYMENT PROGRAMSBundled Payment Programs keep larger share of savings.The Awardee is responsible for Cost Over-runsPIONEER ACOMSSP TRACK 1 ACOBUNDLED PAYMENT PROGRAMPRIMARY SOURCES OF SAVINGS IN ACOS:PRIMARY SOURCES OF SAVINGS IN BPCI:oAdmission and re-admission avoidanceoRe-admission avoidanceoShifting surgeries from hospitals to outpatient sitesoReduced utilization of SNFs, LTACHs and IRFsoReduced utilization of SNFs, LTACHs and IRFsoReduced diagnostic testingoReduced diagnostic testingDistributed by Remedy Partners to Name Here , Proprietary and ConfidentialBundled Payments: Past Present Future
BCPI PROGRAMS DELIVER SUBSTANTIALLY GREATER UPSIDEThe table below compares the net retained savings of an MSSP Track 1 ACO, a Pioneer ACO and aBPCI Program, each with 153M of costs under management. At any savings rate, the BPCI programretains a greater share of savings.ESTIMATED SAVINGS5.0%10.0%15.0%25.0%MSSP TRACK 1 ACO NET GAIN SHAREWITH LOW OVERHEAD( 0.6) 3.4 3.4 3.4PIONEER ACO NET GAIN SHARE WITH LOW OVERHEAD( 1.4) 6.1 11.5 11.5BCPI NET GAIN SHARE WITH LOW OVERHEAD 2.3 9.9 17.6 32.8No cap on upside and lower overhead costs drive outsize advantage for BPCIDistributed by Remedy Partners to Name Here , Proprietary and ConfidentialBundled Payments: Past Present Future
REMEDY OVERVIEWBundled Payments CompanyServices Provided to PartnersoFour Part Strategy:oAnalytics BPCI Awardee ConveneroTechnology Tools National PAC NetworkoRisk Mitigation Services National Bundled Payment NetworkoContracting Support Episode Based Insurance PlansoCall CenteroStatus: Live in BPCI with 22 Programs. 528 inDevelopmentoAdministration and ComplianceoDevelopment Relationships with Over 2,000SNFs, 3,000 Physician Organizations and 198Acute Care HospitalsDistributed by Remedy Partners to Name Here , Proprietary and ConfidentialBundled Payments: Past Present Future
LESSONS LEARNEDoLEADERSHIP: Engaged and committed leadership drives superior performanceoSIZE: Larger programs that include a majority of Medicare FFS cases achieve systematic care redesign andhave less financial riskoPROVIDER ENGAGEMENT Hospitalists and Case Managers are key. Target Physician Engagement.oPATIENT ONBOARDING: Engaging patient and their family/caregivers early: Set ExpectationsoSNF RELATIONSHIPS: Selecting a preferred network, reaching consensus with SNF leadership and creatingincentives to drive outcomesoCMS OBSTACLES: Existing payment rules for home health, SNF and DME require change. Also, newprograms must go live “all at once”oCROWD SOURCING: Creating care plans is a developing art. Contributions from thousands of clinicians is agrowing benefit to collaborationoFAILURE COMES FIRST, THEN SUCCESS: Modifying Care Processes Won’t happen overnightoNAYSAYERS ARE EVERYWHEREDistributed by Remedy Partners to Name Here , Proprietary and ConfidentialBundled Payments: Past Present Future
BUNDLED PAYMENTS – A FUTURE VISIONoSTANDARD EPISODE DEFINITIONS: Open SourceoEPISODE TRIGGERS AT DIAGNOSIS OR ACUTE INTERVENTIONoSHIFT FROM COST BASED TO REGIONAL AVERAGE PRICE TARGETSoCOMPETITIVE BIDDINGoRETROSPECTIVE AND PROSPECTIVE PROGRAMSoEXCHANGE OFFERINGS: EPISODE ALLOWANCES BEAT NARROW NETWORKSoSELF FUNDED EMPLOYERS DRIVE COMMERCIAL BUNDLED PAYMENTADOPTIONoCLINICAL PROCESS OUTSOURCING BUSNESSES PROLIFERATEoINNOVATION DRIVEN BY PHYSICIAN GROUPS – IDS’S EXPOSED FORINEFFICIENCYDistributed by Remedy Partners to Name Here , Proprietary and ConfidentialBundled Payments: Past Present Future
THE NATIONAL BUNDLED PAYMENT SUMMIT: JUNE 17, 2014 . Bundled Payments: Past Present Future. BCPI PROGRAMS DELIVER SUBSTANTIALLY GREATER UPSIDE. ESTIMATED SAVINGS. 5.0%: 10.0%: . INNOVATION DRIVEN BY PHYSICIAN GROUPS - IDS'S EXPOSED FOR INEFFICIENCY; Title: BUNDLED PAYMENTS: PAST, PRESENT FUTURE THE NATIONAL BUNDLED PAYMENT SUMMIT .
UnitedHealthcare Bundled Payments Bundled Payment Summit June 18th, 2019 Washington, DC Jeffrey Meyerhofer President UnitedHealthcare Bundled Payment Solutions Jordan Reigel . Senior Director for Payment Innovation, Cleveland Clinic David Mauzey General Manager, Optum Bundle Pay Manager Agenda 2 Speaker Agenda and Speakers
Medicare and Medicaid Services Innovation Center's (CMMI) Bundled Payments for Care Improvement (BPCI) initiative, a voluntary program encompassing a variety of conditions and risk-sharing arrangements, is the first bundling model CMMI has tested and, thus, the model with the most results. Other bundled payments
Bundled Payments for Care Improvement: The Value Proposition Around Acute Hospitalizations Keywords: Centers for Medicare & Medicaid Services, CMS, bundled payments, models, value, hospitals, acute care, physicians, Partnerships for Patients Initiative, PfP. Created Date: 10/26/2011 12:17:31 PM
Airline Payments Airline Payments Handbook Thomas Helldorff Thomas Helldorff The Airline Payments Handbook : Understanding the Airline Payments World This book puts together "all there is to know about airline payments" into a single reference guide, helping you to answer some of the most prominent payments questions: How do payments work?
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Present Continuous Present Continuous: Spelling U7 Simple Present vs. Present Continuous: Non-Action Verbs Simple Present vs. Present Continuous: Yes/No Questions U8 Future: Will and Be going to Future: Yes/No Questions with Will and Be going to U9 Simple Past Simple Past: Spelling of Regular Verbs U10 Simple Past: Irregular Verbs U11 Can and .
Reading Data in Python Pandas DataFrame. y y Unstructured: Data without inherent structure. Quasi-Structured: Textual data with erratic format that can be formatted with effort. Semi-Structured: Textual data with apparent pattern (including errors) Structured: Deﬁned data model (errors less likely).