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How to transform clinical performance for success with the BPCI Initiative

The Model Performance Period for BPCI Advanced, a new bundled payment model starts Oct. 1 and runs through 2023. It this will require improved variability management and a reduction in clinical variation across the continuum of provider services.

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In the face of rapidly rising costs and a steady stream of regulatory changes, healthcare providers are under enormous pressure to operate more efficiently and at the same time, improve outcomes, quality, and service. Their success will depend on their ability to move from volume-based care delivery to value-based care — a major transformation that won’t be easy in today’s highly competitive and consolidating healthcare marketplace.  Most importantly, it will require an all-out effort by providers to eliminate clinical variation to ensure the delivery of the right care in the right venue at the right time and at the right costs to set the stage for industry-leading, technology-enabled clinical care.

This is not an option; it’s an imperative. The Institute of Medicine estimates that 30 percent of healthcare spending is waste that results from clinical variation. To eliminate such a high level of wasteful spending, hospitals and ambulatory clinics must standardize care, eliminate duplication and redundancy and create more consistent outcomes.

The move toward standardization of care will gather steam as providers gain experience with Medicare’s Bundled Payments for Care Improvement Initiative (BPCI), a payment model that streamlines the Centers for Medicare and Medicaid (CMS) billing process. BPCI incentivizes healthcare professionals to coordinate across the continuum of patient care, reduce costs and improve the continuity of care across the healthcare system. It links Medicare payments to providers for multiple services they provide by grouping them into a single episode of patient care, beginning with an initial medical procedure or hospital stay and extending for up to 90 days of follow up post-discharge. Grouping medical care in this way streamlines the payment process and reduces both administrative costs and clinical variation.

In early January, CMS announced the next generation of bundled payments – BPCI Advanced, which rewards clinicians with additional revenue for improving care management to reduce post-acute care costs and readmissions. Achieving this goal will require improved variability management and a reduction in clinical variation across the continuum of services providers offer. The Model Performance Period for BPCI Advanced starts October 1 and runs through December 31, 2023. Like all models tested by CMS, there will be a formal, independent evaluation to assess the quality of care and changes in spending under the model. Providers have been submitting their non-binding applications for the model through Monday.

The potential rewards of such a model are substantial, borne out by research showing that standard reimbursements over longer periods of time help reduce variability and result in major gains.  Based on Accenture’s own research and experience, as well as analysis by the Healthcare and Information Management Systems Society, Health Catalyst, New England Journal of Medicine and Partners Healthcare, big improvements are possible across the board. The sources for that research are HIMSS, Health Catalyst, Partners Healthcare, Accenture, New England Journal of Medicine:

  • Labor productivity – Possibilities for 40 percent -60 percent reduction in clinical-documentation time
  • Patient throughput – A decrease in length of stay from one to three days for complex conditions
  • Purchasing – A $2,000-$3,000 reduction per patient
  • Avoidable readmissions – A reduction of 20 percent
  • Care quality/patient health – A $12,000 reduction in costs per patient
  • Integrated care – A 10-day decrease in post-acute care

In order to realize such dramatic potential, providers need to focus on how they can best reduce clinical variability and reap the rewards that BCPI can offer. This will be of particular importance for those considering applying for the Model period. Reducing variability will play a critical role in a clinical care transformation journey that is evolving in the healthcare industry.  The transformation is taking shape in three stages of care redesign.

The first stage entails the development of operational standards for foundational clinical care: care team interdisciplinary coordination, levels of care and services management, transitions of care, bed utilization and discharge planning. These areas can help providers identify opportunities to improve patient outcomes and satisfaction while driving down costs. For instance, with analytics, providers can identify and prioritize areas of unnecessary clinical variability within a hospital and across the delivery ecosystem. That data can be shared with clinicians and key stakeholders to facilitate collaborative solutions. The final step would be to implement agreed upon recommendations to provide the support and structure necessary for achieving the favorable outcomes.

In the second stage of transformation, providers offer more advanced care focused on instituting population health – wellness and patient behavior, reducing readmissions, managing high-risk populations, care variance standardization, building a post-acute network and clinical integration. Let’s take hospital admissions as an example. With standardization of care and data-driven care pathways, a 20 percent reduction in hospital readmissions could be a reality.

The final stage in the transformation journey is the creation of an industry-leading clinical care system that manages total populations, delivers virtual care and patient-centered care with a patient flow operations command center.  All of this is enabled by putting analytics, artificial intelligence, machine learning and analytics to their most effective use.

What’s important to remember is that clinical variation is the overuse, underuse and different use of healthcare practices and services in such a way that there is a waste and varying outcomes for patients. By effectively reducing clinical variation in a multi-stage approach, there can be system-wide value and improvements in care. The BPCI Advanced Model is striving for this goal. Providers shouldn’t be fearful of taking a chance to try out the Model for the results will be worthwhile.

 

 

 


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Gerry Meklaus

Gerry is Managing Director, Accenture Health, has many years of experience in business transformation for healthcare organizations, particular provider entities seeking high performance in an evolving industry. As a managing director for Accenture Health, Gerry uses his deep expertise in physician practice administration, revenue cycle and electronic medical records to improve efficiencies and outcomes for all stakeholders.

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