Achieving Success in BPCI Advanced
Thursday, June 13, 2019 | Joseph Sasson
To participate or not to participate, that is the question… The BPCI-Advanced Cohort 2 application window closes soon on June 24th, 2019 and we’re hearing some provider organizations question their ability to navigate the program and be successful given the presence of both upside potential and downside risk. With this question, and looming deadline in mind, we’ve identified commonalities among providers that have shown strong early results in Cohort 1. If you are wondering if BPCI-A is right for you, the attributes below can serve as a guide for thinking about participation in the program.
- Believe in value-based care: Organizations succeeding in the program went into it because they are believers in value-based care. CMS is not slowing down its transition from fee-for-service or transference of risk to providers; in fact, the agency is speeding up and planning to release four new mandatory models it announced last year. Successful BPCI Advanced participants see the program as a vehicle for that transition.
- Dedicate the appropriate resources: Participants need the right technology and personnel resources supporting the program. This includes executive sponsorship, knowledgeable program managers, dedicated care coordinator(s), physician leadership, and care management and performance analytics tools.
- Gain stakeholder buy-in: BPCI Advanced organizations that have done well so far have aligned strategies for success, both among physician leadership and ‘boots on the ground’ administrators and clinicians involved directly in providing care.
- Set performance goals: Participants need clearly-defined goals and a way to track against them. Examples from current participants include readmission rates, ER rates, post-acute utilization, and more. By reviewing historic performance, participants can identify actionable levers and set goals.
- Identify, assess and track patients in the program: Successful groups have developed a process to identify BPCI Advanced patients in real time. Then, with the right technology and clinical assessment tools, participants can determine patient-specific care pathways and track against them using patient tracking tools.
- Establish a preferred provider network: By working with a select group of post-acute providers and collaborating with them on success metrics, BPCI Advanced participants can manage the continuum of care and help patients stay on track with their care pathway.
- Redesign care models: The success of BPCI Advanced hinges on implementing care model redesign, including the hospital discharge process and other care delivery aspects.
- Educate patients: A primary goal of bundled payment programs like BPCI Advanced is to improve care outcomes and help patients to get better and get home faster. Successful practices are committed to engaging patients in their care, educating patients about the program, and setting expectations for follow-up visits.
One attribute that successful BPCI Advanced participants don’t necessarily have is experience in value-based care. Bundled payment programs are ‘learn by doing’ endeavors that don’t require prior experience to be successful. We’ve seen providers both with and without prior experience in value-based care find success. Many of the attributes of successful BPCI Advanced participants are exemplified by “nature versus nurture” – some are inherent to a practice’s culture, while others can be learned.
Success in cardiovascular bundles – Phoenix Heart
One cardiovascular group who’s had success executing this program and these guidelines is one of Archway Health’s provider partners, Phoenix Heart PLLC. Phoenix Heart is a cardiology group with six offices in the greater Phoenix area, performing a wide range of services for its patients, including percutaneous coronary intervention (PCI), which it offers as part of the BPCI-A program. One of the challenges that Phoenix Heart CEO, Kyle Matthews, faced when introducing the BPCI Advanced program to the group, was getting physicians to buy in. A recent case illustrated how the program not only saves money – it can help improve outcomes, and even save lives.
A timely intervention
To find success in any bundled payment program, a provider must closely track a patient’s journey throughout the entire 90-day episode of care. When the Phoenix Heart staff discovered that a patient who had recently been in for a PCI procedure was no longer in contact, they knew they needed to take action quickly. By using Archway’s patient tracking tool, Carelink, and other care management tools, the team discovered that the patient had been dispatched by another physician to a rehab facility for a non-cardiac-related issue. Additionally, the patient was not receiving the medication they were supposed to take after their discharge, leading to a potentially life-threatening situation.
Phoenix Heart physicians immediately arranged for the patient to be put back on the medication and set up an appointment at a Phoenix Heart office for the next day. The patient was “very sick” when they arrived, says Matthews.
Because the patient's case was part of a bundled payment program, which requires constant and clear communication between all of the providers involved, Phoenix Heart was able to make a timely intervention and put the patient back on the road to recovery.
“We really credit the bundle for putting the patient back on the right track, especially getting them on the medication they should have been on in the first place, and potentially saving their life.”
Transforming physician engagement
As a result of this case and continued staff education, BPCI Advanced has helped turn Matthews’ colleagues into more engaged bundled care providers. “I think they feel a little more attachment to their patients,” says Matthews.
“This event happened early on, and this story is being told in physician meetings...it really brought home the clinical piece of it. It helped my colleagues understand – ‘OK, now we see why this is being done, why there is a focus on these types of things.' I do believe it gives a lot more credence to the program."
With its providers engaged in BPCI Advanced, Matthews can focus on helping Phoenix Heart differentiate itself from other physician practices, which he says was a significant factor in Phoenix Heart’s decision to work within the BPCI Advanced framework. The program gave Phoenix Heart the ability to offer quality-focused care that would be more attractive to regional and national health plans alike.
“I think it puts us ahead of the curve when it comes to value-based care,” says Matthews.
Time is running out
The last open window for providers to join BPCI Advanced is coming this month. Some Cohort 2 program modifications, including a revised TAVR bundle, cardiac rehab incentive, and new Alternate Quality Measure set, create additional opportunities for cardiovascular groups. We encourage providers interested in the program to submit the non-binding application, get their data, and evaluate the program risk-free. Knowledge is power, and this benefit to MedAxiom members should not be overlooked.
Illustration: Lee Sauer
About the Author
Joseph Sasson, Ph.D. is Executive Vice President of MedAxiom Ventures. Joe's work includes helping MedAxiom members to access the technologies and solutions they need most to effectively run their organizations and prepare themselves for the future of value-based care. Simultaneously, Joe works with dozens of companies in med-tech, device, pharma, imaging, cath labs/ASCs, and health IT to deliver economic value propositions and strategies to help companies accelerate commercial growth.
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