Value-based purchasing has been a recent topic in the healthcare industry spotlight and on July 1st, the latest wave of Bundled Payments for Care Improvement (BPCI) for providers went live. We’ve noticed hospitals and post-acute providers alike are realizing they have skin in the game and there are some common themes that come up during bundled payment discussions.
BPCI Model Two and Model Three Top Preferences
Hospitals tend to prefer BPCI Model 2 which includes the hospital costs, yet the BPCI Model 3 is better for post-acute providers since it allows them to better manage risk. This creates tension between the two sides as post-acute providers may opt for Model 2 if they want to be included in the bundled payment networks that hospitals are setting up. Although hospitals and health systems will likely get to determine the terms of participation, they should keep in mind Model 2 means that hospitals’ costs will impact post-acute providers, who already face declining margins. Post-acute providers participating in Model 2 will have to work with hospitals differently than they do now.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
Narrow Networks for Post-acute Providers
Many hospitals believe that the biggest costs exist in the post-acute market, so they have begun to build out narrow networks of post-acute providers. However, hospitals are not always sure which post-acute providers can deliver the cost savings and post-acute providers will need to collaborate with hospitals to drive down costs of the bundles. Patient care performance will be the driving factor for inclusion in a narrowing network of post-acute providers. Once those networks are defined, the next challenge for hospitals and health systems who are tackling bundled payments will be to make sure patients included in the bundles are being sent to providers in those same networks.
Third Party Post-Acute Care Management
Unless a post-acute care setting is owned by the same health system, hospitals traditionally don’t have much influence on the care provided within post-acute care settings. As a result, some haymentsgage third-party organizations to help manage those patients in the post-acute care setting. This not only added costs, but also the challenge of trying to incorporate those parties into current care workflows.
Testing Out Bundled Payments
Hospital and health systems are looking at the Bundled Payments for Care Improvement as an experiment and are trying out different bundles, as well as various intervention and support strategies across different hospitals. Since there currently isn’t one definitive solution, hospitals and post-acute providers have an opportunity to successfully manage bundled payments together. Hospitals and post-acute providers must think about the three fundamental steps that are required for success:
- Establish a method upon hospital admission to pinpoint the right patients who should be included in the Bundled Payment program.
- Identify intervention opportunities within each care setting (e.g., hospital, SNF, home health) as well as during care transitions between those settings. Strengthen the relationships between hospitals and post-acute providers.Photo:
Flickr user: https://flic.kr/p/78JmqHedlabdesigner
