Selecting the Right Partner for Your Bundled Payments Program

Value-based care continues to transform how care is designed, delivered, measured, and paid for. Recent CMS announcements have conveyed that these efforts will continue through healthcare innovation, increased focus on physicians, and new payment models. CMS has also indicated that the next generation of the Bundled Payments for Care Improvement (BPCI) model is still imminent, providing opportunity for physicians to reduce costs and improve quality.

Selecting the right partner to help manage not only the new BPCI model, but all bundled payments, is key to success. Health organizations ask us all the time what makes us different from other partners—as they should. When it comes to selecting a partner, it’s important to be an ‘informed shopper.’

Below is list of questions to consider that when selecting a bundled payments partner, and how Archway addresses each.

Your Needs
Assess your level of need and desired level of involvement before jumping into a relationship with a bundled payments partner. 

  • Does your practice have experience with bundled payments or other risk-based programs?
  • Do you prefer to manage the care of your own patients or would you prefer to outsource care management?
  • Do you want a full service partner or only select services?

No matter your level of need or sophistication, we offer a complete solution that frees your practice to focus on what matters most: medical treatment and care delivery.

Experience
Many companies have come onto the bundled payments scene in anticipation of the new BPCI model. A partner that has already participated in first BPCI program will have more experience and insight that will benefit your practice.

  • How long has the potential partner been involved in bundled payments?
  • Are they focused solely on bundled payments?
  • Do they have experience working with specialists?
  • Have they conducted CMS reconciliations for BPCI?

At Archway, we are 100% focused on bundled payments—it’s all we do. We direct that focus toward helping practices succeed. We have also reconciled our data, meaning we’ve learned from our own, and others’, mistakes.

Care Management
Bundled payment programs are not just about the money and technology—they can positively impact how you care for patients.  

  • Does the potential partner have a real-time patient tracking platform? Will your care delivery partners adopt it?
  • Who interfaces with your patients – your team or your partner’s?
  • How do they develop preferred provider networks?
  • What is their experience with gainsharing agreements?
  • What do their current customers say about them?

Archway helps providers evaluate, design and manage bundled payment programs through the entire episode of care. Our goal is to collaborate for improved care delivery and better patient outcomes.

Data Analytics
As the famous Peter Drucker said, “If you can’t measure it, you can’t manage it.”

  • How quickly is data available each month from the potential partner?
  • Do they have a web-based delivery platform?
  • How comprehensive are their data dashboards?

Archway’s technology platform and services include online analytics, care management and patient tracking tools, redesign services, financial reporting, and ongoing operations.

Performance (Quality & Financial)
When evaluating partners that have experience to show, take a close look at the results, both in quality improvement and cost reduction.

  • What quality metrics is the convener tracking in BPCI?
  • How have they improved quality and the patient experience?
  • How are your potential partners’ clients doing in the current BPCI?
  • How much are they saving per episode—in dollars and percentages?

Specialists working with Archway have earned on average $2,000 extra revenue per case in BPCI, while improving patient outcomes.

Risk
Deciding how you want to manage risk is one of the toughest parts of implementing a bundled payments program.

  • How much risk do you want to accept?
  • Do you want to take on the risk alone or share risk with a partner?
  • Will they help you meet the program’s Letter of Credit requirements?

Archway partners with providers to share risks and rewards, which means we don’t get paid until our partners succeed.

We are confident that bundled payments can help grow your practice, and we’re committed to helping you navigate and succeed in these bundled payment programs. In a half-hour consultation, we can help you learn more about the imminent BPCI program update, and find your potential savings in a provider-specific Bundled Payment Scorecard. To learn more, contact our team at info@archwayha.com.

Keely Macmillan Featured in Health Leaders

Archway Health's General Manager of BPCI, Keely Macmillan, was recently featured in an article by Health Leaders discussing the federal government reducing medicare payment for outpatient drugs in CMS' 340B program. She says, "Right now, the hospitals make a big margin on these drugs they're purchasing and can use that money how they want," Macmillan says. "The intent of the program is commendable, to help safety net hospitals that care for our most vulnerable population, treating the uninsured and the most Medicare and Medicaid patients. The biggest failure of the 340B program has been a total lack of transparency and accountability on the dollars that flow through this program." 

Read the full article here

Connected Health Conference: Hardware and Software Solutions for Healthcare

The 2017 Connected Health Conference, held in Boston, MA in October, brought together healthcare leaders to discuss innovations and technologies that are transforming the industry. Some of our own Archway team members attended the conference, which centered around understanding and interacting with digital healthcare and how it relates to patient engagement, data exchange, clinical care, and new research and evidence.

Technology Meets Usability in Hardware

The first step in identifying and managing episodes of care is finding ways to efficiently connect all of a patient’s care team to ensure that all involved providers have access to relevant health records. This type of electronic sharing of health records will improve care coordination and reduce treatment errors. While strides are being made to improve interoperability, healthcare is still lagging when compared to the big technology companies entering the industry, such as Amazon and Google.

As seen at the Connected Health Conference, many technology vendors are trying to solve healthcare providers’ need to efficiently manage patient care. At Archway, we believe there is value in placing the patient in charge of their health data. Patient engagement is key – those who actively participate in their care have better clinical outcomes.

A portable device like an encrypted USB that contains basic health history can be a great tool for patients to bring to their lab appointments, specialists visits, rehab facilities, etc. “Wearable” technology pieces like a glucose-monitoring watch and headphones that monitor pain and discomfort are all able to track health patterns and retain that data for providers to access and use.

With these patient-initiated systems in place, providers are able to view a summary of a patient’s health at each episode of care, creating a consistent stream of valuable health information collected from all parties.

Technology Meets Feasibility in Software  

Using care management software as a means of managing specific patient conditions is also trending in the industry. This brings greater value to providers and an easier way to manage patient care delivery. At Archway, our real-time patient tracking system, Carelink, is a unique tool that can be used to monitor episodes of care. With Carelink, providers can deliver better care to their patients, and see improved collaboration within the care management team.

Carelink allows providers to see how patients are tracking on their care plan and schedule, how they are feeling, and the financial status of the episode of care. And it provides real-time answers. Carelink takes inputs from both patients and providers to facilitate timely communication between both parties throughout the episode.  

Better care can only be achieved by stronger management of patient episodes of care. Episodes of care connect all aspects of healthcare technology – from coding and claims to data and diagnosis. Defining an episode of care in a value-based payment world can identify the care that is given and the future health of the individual.

Throughout time, healthcare and technology will only continue to grow more connected. The Connected Health Conference not only confirmed, but celebrated, the great health-tech resources that are aiming to make healthcare safer, stronger and better. Whether it’s hardware or software, patients and providers alike should be ready to incorporate these helpful tools into their habits.

Archway Health Launches User Experience Enhancements to Carelink

We are proud to introduce design enhancements of our proprietary patient tracking tool, Archway Carelink, a software platform part of our bundled payment management suite. The updates and enhancements reflect specific client feedback and address elements specifically requested. We are committed to continuously improving our platform to make sure that our clients have the best tools and resources to succeed in bundled payments. The design updates were made in collaboration with a leading user experience firm, UXL.

With this redesign, we developed an interactive, comprehensive dashboard for patient monitoring. It includes a streamlined episode list and an episode record, which tracks patients throughout the care journey.

New Dashboard

The new Carelink platform includes changes to the tactical dashboard  made based on users’ feedback; the original text-only dashboard was updated for usability to better engage program managers and nurses monitoring patients at facilities, and make it easier for them to use the platform and glean insights.

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Episode List

In this update, we also streamlined the episode list, a key part of our tracking tool. Now, it extracts the most relevant data and organizes it in a clear and digestible hierarchy of information. This allows the users to more easily search, filter and parse patient data, and ultimately, more efficiently monitor patient information.

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Patient Updates via Text  

We added new features to our messaging capabilities via text in this update to help maintain patient communication. Now, Carelink will ask patients to numerically rank how they are feeling. In the event that the patient is not feeling well, Carelink will automatically respond with information to contact their care coordinator. With this update, care coordinators can keep a better eye on patients at home and help avoid any adverse outcomes. 

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Visual Redesign

All of our redesign efforts were made with the user in mind. Our goal is always to make our platform easier and more desirable to use. Based on user interviews and feedback, we developed a final product that simplifies usability, improves efficacy, and has a strong visual direction for this application and all on-going advancements.

At Archway, our patient tracking tools are a key component that contributes to our service of ensuring success for providers in bundled payments. We believe these tactical and user-friendly updates to our platform will improve the experience of both the provider, and the patients their care for. And, as always, please let us know any feedback on the platform.  

CMS Testing Episode Cost Measures for Future Payment Program

As the healthcare industry continues to innovate, the Centers for Medicare & Medicaid Services (CMS) is charging forward to test and roll out new payment models. In October, CMS announced the field testing of eight, physician-driven bundles that could be used in the cost performance category under the Merit-based Incentive Payment System (MIPS) in the future. While MIPS may be on the chopping block, do we really think that’s likely to happen?   Previous CMS testing gives us reason to believe that CMS may incorporate its findings into future bundled payment programs.  

The eight episode cost measures include:

1.     Elective Outpatient Percutaneous Coronary Intervention (PCI)
2.     Knee Arthroplasty
3.     Revascularization for Lower Extremity Chronic Critical Limb Ischemia
4.     Routine Cataract Removal with Intraocular Lens (IOL) Implantation
5.     Screening/Surveillance Colonoscopy
6.     Intracranial Hemorrhage or Cerebral Infarction
7.     Simple Pneumonia with Hospitalization
8.     ST-Elevation Myocardial Infarction (STEMI) with (PCI)

CMS released specifications for the bundles including new trigger site criteria; some of these bundles also include pre-trigger periods ranging from 30 – 60 days.  

Before we expand further on this topic, let us pause to acknowledge that your experience is important, and CMS wants to hear from you. Share your feedback through an easy, online survey on these test measures by November 15, 2017.

Another Win For Physicians

In all of these episode-based cost measures, or bundles, the episode is attributed to a physician. This confirms and reinforces the priorities outlined in the RFI released in September concerning the Center Medicare and Medicaid Innovation (CMMI) “new direction.” The content of the RFI strongly suggested the prioritization of physician-driven models, and CMS continues to reaffirm its commitment with the field testing of these new physician-focused cost measures. Like CMS, we see value in this approach as evidenced by our experience. Bundled programs can be successfully utilized across the continuum of care, however, specialist providers are among the group to most consistently demonstrate value when owning the bundle.

Outpatient Bundles

For five of the eight bundles, the trigger event can take place in an ambulatory setting, indicating CMS is exploring the implementation of outpatient bundles. Ambulatory bundles have been an untapped source of savings for CMS. These bundles are more conducive to physician-driven, value-based care, and eliminate the reliance on MS-DRG assignment, which has been a challenge for Bundled Payments for Care Improvement (BPCI) participants. Adoption of the outpatient knee arthroplasty measure was contingent on CMS’ decision to pay for the procedure in the hospital outpatient department setting, which CMS confirmed it would on November 1, 2017.  Field testing of outpatient bundles also helps inform improvements in the physician attribution process, improvements which may be adopted in the next generation of BPCI.

New physician attribution

CMS is also exploring an alternative attribution methodology for the new inpatient-anchored bundles it is testing. In the current BPCI program, bundles are attributed to the attending or operating physician on the inpatient claim. CMS has intimated that hospitalists being assigned the bundle was an unintended consequence of the program’s design.  

For the new bundles triggered by an inpatient admission, the attributed clinician is the clinician who renders at least 30% of the evaluation and management services provided during a hospitalization. It is clear that hospitalists, who care for patients while in the hospital, are not the best-suited providers to care for a patient 30-60-90 days after discharge, and this new method may reveal opportunities for improvement in upcoming programs.  

How to Participate

Archway is glad to see CMS moving full speed ahead in developing physician-focused innovative payment models. Regardless of how the MIPS final rules work, we are pleased to see CMS learning from past programs to enhance future advancements in alternative payment models.

Share your feedback with CMS by November 15, 2017.

We also strongly urge physicians to access confidential feedback reports on these measures. For those participating in any of the eight bundles above, you may be able to view your Field Test Report on the CMS Enterprise Portal. There is further information on the MACRA site. If you need any help understanding your data and reports, please contact us at info@archway.com to arrange a one-on-one discussion.

Specialists Can Do Better by Pursuing APMs over MIPS

Archway Health recently attended a conference focused on educating specialty practices about key industry trends; one of the conference breakout sessions was dedicated to helping specialists understand and succeed in MACRA’s Merit-Based Incentive Program (MIPS). MIPS, intended to incentivize and reward physicians for providing efficient, high quality care, adjusts physicians’ Medicare FFS rates upward or downward according to their relative scores in four performance domains: Quality, Clinical Practice Improvement Activities, Advancing Care Information through EHR technology, and efficiency.

Every specialty practice participating in the MedAxiom breakout session had already invested significant resources preparing to meet MIPS reporting requirements; however, when surveyed, only one practice had the goal of earning additional money under MIPS; the rest simply aimed to avoid a penalty.  

It is highly disconcerting to watch our nation’s leading specialists spend limited time and resources with an end-goal of not being penalized under a reimbursement system that already underpays its doctors. Because MACRA eliminates annual rate inflation under the Medicare Physician Fee Schedule, even with the avoidance of a MIPS penalty, doctors will still fail to break-even due to higher input costs. Acknowledging MIPS’ poorly designed structure, the Medicare Payment Advisory Commission (MedPAC), which advises the Centers for Medicare and Medicaid Services (CMS) on Medicare payment policy, recently recommended revising the Merit-Based Incentive Program (MIPS), citing the burden the policy places on providers, with little return in care improvement.  

Instead of wasting resources “just trying to survive under MIPS,” as one practice manager put it, practices should be investing to thrive in the Bundled Payment for Care Improvement (BPCI) ‘Advanced’ program, the only option for most specialists to qualify for the Advanced Alternative Payment Models (APMs) track under MACRA. Under Advanced APMs, physicians have the opportunity to earn significantly greater revenue, avoid the risk of penalty under MIPS, receive an additional 5% bonus annually if a minimum percent of their Medicare patients are attributed to the APM, and receive substantially more robust and timely patient level performance data; further, physicians can establish a foundation for success under commercial Value Based Purchasing.  

At Archway Health, we’re encouraged to see the new priorities for the Center for Medicare & Medicaid Innovation (CMMI) focus on creating more specialist Advanced APMs, including the BPCI-Advanced program which is expected to be announced this fall.  CMS is currently testing eight outpatient bundles, including Knee Arthroplasty, signaling their intent to adopt outpatient bundles in the next generation BPCI program and engage a broader range of specialists.  

Our specialists deserve better than a failed return on investment under MIPS. We believe that qualifying for the Advanced APMs track through BPCI Advanced is not only the better option under MACRA’s Quality Payment Program—it’s a better business solution.  Bundled payments can help grow your practice, and the Archway team would love to share more of our ideas and solutions for how you can do this.

Third Annual BPCI Evaluation Signals Improvements for Future Value-Based Payment Models

The Centers for Medicare and Medicaid (CMS) released in October the third annual Bundled Payments for Care Improvement (BPCI) evaluation report, produced by healthcare consulting firm The Lewin Group. Skeptics of this particular CMS Advanced Alternative Payment Model (APM) say it is difficult to confirm whether or not the payment model is beneficial. However, we were encouraged by the report, as it demonstrates where BPCI bundled payments have been successful, and addresses program design deficiencies that CMS has begun correcting in newer programs.

Quality Performance

With regards to quality, the 2017 BPCI report did not show significant improvement among the program’s participating providers. While CMS does track quality performance in BPCI, provider payments are not adjusted by quality scores, signaling a lack of concrete incentive for providers.

CMS began to address this shortcoming in more recent bundled payment programs, including Comprehensive Care for Joint Replacement (CJR), Oncology Care Models (OCM) and the recently canceled Episode Payment Models (EPM) by adopting quality scoring methodologies that impact provider reimbursement. And, in the forthcoming next generation of BPCI, CMS will close the loop by requiring that provider payment be adjusted by quality performance so that providers qualify for the Advanced APM track under Medicare Access and CHIP Reauthorization Act (MACRA).

Target Pricing Methodology 

The BPCI report also statistically confirmed previous concerns voiced by providers about the program’s pricing methodology. The current BPCI methodology is based on provider-specific historical data; participants are rewarded for improving efficiencies in relation to their historical spend. As a result, many providers who had already made efforts in care redesign before the start of BPCI opted not to participate in the program, as they’d be disadvantaged under the target pricing methodology.

In the subsequent CJR and EPMs programs, CMS incorporated regional spend into target prices to incentivize high-performing providers to continue to engage in care improvement efforts. For OCM, CMS adopted national pricing factors to establish more equitable target pricing among participants. Additionally, CMS has indicated that the next version of BPCI will strive to bring both highly efficient and less efficient providers into the fold.

Reliance on Medicare-Severity Diagnosis Related Group (MS-DRG) Assignment
The 2017 BPCI report also revealed challenges in determining the appropriate bundle for patients with comorbid conditions. Currently, episodes in the BPCI program are triggered by an inpatient admission, and the corresponding MS-DRG assignment dictates the target price. For patients with multiple diagnoses, it can be difficult to know which bundle the patient will be assigned to.

CMS recently announced it is field-testing new ambulatory bundles for physicians under the Merit-based Incentive Payment System (MIPS).  These bundles demonstrate CMS is looking to identify ways to define bundles that are not reliant on MS-DRG assignment. And, in finding more effective ways to assign bundles to the most appropriate physician, instead of defaulting to the attending or operating physician at the time of admission, CMS will have better insight to create a more adaptable assignment system for future bundled payment programs.

Turning Hindsight into Foresight

Archway was also encouraged by the physician-focused language in last month’s RFI concerning CMMI’s “new direction” as we believe this is a peek into the future of value-based payment models. Based on the language and priorities outlined in the RFI, Archway predicts that forthcoming payment models, including BPCI Advanced, will be more inclusive of specialty and independent physician practices.

So, despite limited data and some program design flaws, the third annual BPCI evaluation report reinforces that this innovative program is driving change in the healthcare market. BPCI participants consider bundled payments as “the future of payment reform” as they continue to be a championed tool of value-based care for Medicare, commercial payers, and employers.

Learn how Archway can be an ideal partner for your organization to participate in future bundled payments.

Specialist Engagement is the Key to Bundled Payment Success

In the last 6 years or so, bundled payment activity has picked up tremendously with the Centers for Medicare & Medicaid Services (CMS) both mandating and offering several programs aimed to help providers achieve efficiencies in care. We're encouraged that in a recent article, Modern Healthcare picked up on the success that providers are experiencing within the CMS’s Comprehensive Care for Joint Replacement, or CJR, and Bundled Payments for Care Improvement, or BPCI, programs. While the success highlighted in the article focused on orthopedics and procedural care, both Medicare data and our experience demonstrate that this success has also included significant improvements in quality and cost in chronic conditions like CHF and COPD, even in cancer care with Medicare's Oncology Care Model, or OCM, program.

The key to success has not been what is bundled, but rather who is bundling. A deep look into the data reveals that programs in which specialists are deeply involved have had the most success in both improving care, cutting costs and achieve efficiencies.

Having worked with BPCI, CJR, and OCM participants since the inception of these programs, we have learned that there are four keys to unlocking this level of success with bundled payments programs. And, these work within almost any high-cost, complex acute or chronic condition:

  1. Put the specialists in charge of the process.

Medicare data of BPCI bundles reveal that specialists are well-positioned for leadership and of bundled payment initiatives. In programs with strong specialist leadership and alignment, we have seen costs reduced by more than 14%, where as hospital-driven bundles without specialist engagement saw savings of just 4%.  In addition to lowering costs, specialist led programs achieved greater decreases in length of stay and declines in skilled nursing facility utilization.

  1. Engage high-volume specialists in critical clinical areas, like orthopedics, cardiology, pulmonology, and oncology.

Orthopedic specialists have gotten a lot of attention in bundled payments with the CJR program. But, with potential cuts to the CJR program, the success of voluntary models can fill the void in a more participatory, rather than mandated way. Additionally, other high-volume specialists should be a major focus, and not avoided.  Complex patients who have historically used lots of resources are also generally have significant variability in costs and outcomes, these patient populations present the best opportunities for improving the process and achieving better results.

  1. Give the specialists the full data sets.

A major factor in any bundled payment success is data. Specialists have to be able to see not only their own, but also data from the full continuum and their peers, to gain a full understanding of where the costs go and what happens to the patients over the course of a complete episode of care. This helps specialists identify the path to improvement for the patients they care for.

  1. Encourage specialists to innovate around the best way to care for their patients across the full continuum of care.

Once specialists are participating in bundled payment contracts and examining the data, in our experience, they begin to innovate all kinds of new and improved ways to care for their patients.

When all four of these elements are at play, we see tremendous improvements in the process, outcomes, the patient experience, and costs start to come down dramatically.

While some were disappointed that the CMS recently scaled back the mandatory programs, the agency has also repeatedly indicated that it will be implementing the next generation of the voluntary BPCI program soon.

Given this continuation and the physician-focused language in the latest RFI concerning CMMI’s “new direction,” we expect the new program to provide even more of an opportunity for specialists—even high-performing ones—to participate in and benefit from value-based payment reform. With the success of the original BPCI programs, CJR and OCM, we expect to see significant demand among specialty physicians and their hospital partners  in the upcoming program.

Archway Health Expands Commercial Bundles with New Analytics Team

WATERTOWN, Mass.--(BUSINESS WIRE)--As bundled payments continue to be a championed tool of value-based care, Archway Health has hired four senior team members to boost the organization’s analytical operations for Medicare, health plan and employer-based bundled payment programs. With this team, Archway will continue to be a leading partner helping health plans, employers and specialty healthcare providers design and manage bundled payment programs.

Mah-Jabeen Soobader, Ph.D, MPH, joins in a new role as chief analytics officer. She will steer the strategic progression of payors and providers that are transitioning to and designing value-based care programs. Archway has also hired Jun Wang, Ph.D, M.D., principal data scientist; Yuze Shang, M.S., senior technical analyst; and Victoria Yang, M.P.H, M.Sc., senior product analyst.

“This new team of highly-skilled and experienced analytics and product design professionals will take our commercial bundle capabilities to the next level,” said Dave Terry, Co-founder and CEO. “At Archway, we are committed to building out each aspect of our business to continue to stand out in the marketplace as the premier bundled payments partner for participants in all settings.”

Dr. Soobader is a nationally-recognized subject matter expert in bundled payments and value-based reimbursement with a proven history of developing successful analytics and platform solutions for the healthcare industry. Her portfolio includes partnerships with several nationally-acclaimed health systems and specialty centers. She holds a doctorate in social epidemiology, a Master of Public Health from Boston University’s School of Public Health, and a degree in optometry from the University of Durban-Westville, South Africa.

Jun Wang, Ph.D, M.D., joins Archway as principal data scientist, bringing more than 10 years of experience in the design, development and implementation of Medicare, Medicaid and commercial bundled payment initiatives, such as Bundled Payments for Care Improvement (BPCI), Comprehensive Care for Joint Replacement (CJR), and Oncology Care Model (OCM). Her previous experience includes production of the original SAS analytic packages for the Prometheus bundled payment model, and design of 39 custom bundled payment arrangements for commercial programs. Dr. Wang earned a doctorate from Keck School of Medicine at the University of Southern California and holds a medical degree from Beijing University’s School of Medicine in China.

In the role of senior technical analyst, Yuze Shang will manage the development of data verification and integrity programs. She has been previously involved in launching BPCI and CJR analysis models, and she holds three certifications by SAS as a Base, Advanced and Clinical Trials Programmer. Shang earned a master’s degree in physiology from the University of Toronto and a master’s degree in business economics from the University of Medicine and Dentistry in New Jersey.

Victoria Yang joins Archway as senior product analyst from a similar role with nThrive, where she performed research and analysis on CMS value-based payment programs to support product design. Yang also previously worked as a clinical analyst at Yale-New Haven Hospital where she led the research modeling and analytic reporting for multiple high-risk cancer studies, in addition to leading outcome measurement. She holds a master’s degree in biomedical science and molecular biology from George Washington University and a master’s degree in epidemiology from Yale University.

About Archway Health Archway Health, founded in 2014 and built on a deep foundation of healthcare payment reform expertise, works with providers to design and execute care and risk management programs that drive success in bundled payment programs. Archway is currently working with leading healthcare providers participating in the CMS BPCI and OCM programs, as well as with commercial payers operating bundled payment initiatives. To support these programs, Archway works with providers to analyze their opportunities and risks and to deploy its comprehensive platform of analytics, patient tracking tools, and advisory services to ensure their success in bundled payments. For more information, please visit www.archwayhealth.com.

Contacts

For Archway Health Olivia Armstrong, 781-924-6714 oarmstrong@hencove.com

HealthExec Q&A on CMMI's "New Direction"

Last week, Archway Health's CEO, Dave Terry, and GM of BPCI, Keely Macmillan, were interviewed by HealthExec on their predictions of where this 'new direction' will take CMMI. "I do think this new administration, whether they might have a different approach or just a different name, they do genuinely want to get rid of waste in the system and reduce unnecessary federal spending," Macmillan said.  "Regardless of who you are, I think the need to reduce excess spending by Medicare and redirect those funds is universally recognized." CEO Dave Terry correctly predicted that the new leadership would change the participation of the program from mandatory to voluntary, and he believes that this transition paves the way for voluntary success. Terry said, "What we saw with the mandatory models is not very high engagement from the participating hospitals and really watered-down rules to make it palatable. It just really didn’t move the needle on improvements. The voluntary ones, you see tremendous engagement from the physicians and providers, you see them moving the needle quickly and effectively, and that starts to change markets. You don’t need that many participants to wake up the competition and start moving towards improvement. We actually think the voluntary ones will change and shape markets faster than the watered-down mandatory ones."

Read the full Q&A here.

CMMI’s “New Direction” Points to the Future of Bundled Payments

A “new direction” is how the current Administrator of the Centers for Medicare and Medicaid Services (CMS) described the agency’s Innovation Center: Center for Medicare & Medicaid Innovation (CMMI). Seema Verma, the current Administrator of CMS, wrote a Wall Street Journal op-ed declaring the new changes for CMMI. With the proclamation come myriad questions. Perhaps most notably, what is the future of value-based care and what tools and payment models will organizations be able to leverage?

CMS’s recent Request for Information (RFI) supports Verma’s announcement and confirms that more inclusive, innovative care models, including bundled payments, are the future of healthcare.

After reviewing the RFI and other communications from CMS regarding the “new direction,” the team at Archway Health is encouraged by the tone and believe it reiterates a commitment to bringing more providers into the fold of innovative care.   

Embracing Bundled Payments

The priorities outlined in the RFI provide insight into what will be emphasized in this ‘new era’ of CMMI. The first three items on their priority list are Advanced Alternative Payment Models (APMs), Market-Based Innovations, and Physician-Driven Specialty Models. Bundled payments, and value-based specialty networks directly support all of these priorities by providing proven opportunities for cost reduction and quality improvement. As a result, we are confident that bundled payments will continue to play an integral role in the structure and payment of healthcare.  

The language included throughout the RFI also indicate that bundled payments are not slowing down anytime soon. Just last month, CMS proposed cancellations of two mandatory bundles, but bundled payments and episodes, particularly voluntary programs like the Oncology Care Model (OCM), are reinforced several times throughout the RFI.

Takeaway: Bundled payments remain a key to addressing healthcare payment reform and innovative models for care.

Physician- and Specialty-Driven Models

Notably, accountable care organizations (ACOs), hospitals, and PCPs were not mentioned at all in the RFI—a major shift in focus from an agency that once championed these care settings. This lack of inclusion gives us reason to believe that bundled payments will not only continue, but will be underscored as viable paths for physicians’ success under the APM track. In addition to a shift in focus of providers, discussion in the RFI of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) initiative, centered on developing physician-driven APMs, indicate that CMMI will much more focused on specialty care and specialty physicians.

Takeaway: The future of value-based care will be more inclusive of specialty and independent physician practices.

New Models Still Imminent

CMMI’s priorities and language throughout the RFI for its “new direction” signal that forthcoming programs, including the next generation of BPCI, will not be slowed down by the agency’s shift.

CMS has indicated that it is continuing to move full speed ahead with new models currently under development. We believe the agency-wide change in direction not only aligns with the aims of current programs in development, it further reinforces them.

Takeaway: Physicians should seriously consider and prepare for participation in new bundled payment models.

In a free, half-hour consultation, we can help healthcare providers, and specialists in particular, learn more about the imminent BPCI program update, and find potential savings in a provider-specific Bundled Payment Scorecard. To learn more, we welcome you to contact our team at info@archwayha.com.

Archway Health in Skilled Nursing News

Archway Health CEO Dave Terry was recently quoted in Skilled Nursing News' article "Skilled Nursing Providers Have Mixed Feelings on Bundled Payments". The article discusses a recent survey conducted by Archway Health that examines how Bundled Payments for Care Improvement (BPCI) both lower the cost of post acute care and enhance care quality. “Of folks who actually participated, [if you asked], have you seen improved quality and reduced costs, I think you’d see both,” Terry told Skilled Nursing News. “This is a pretty broad audience, who might be getting ready to participate.”

Read the full article by Skilled Nursing News here.

Archway Examines the Impact of Bundled Payments Ahead of Expected New CMS Programs

WATERTOWN, Mass.--(BUSINESS WIRE)--According to a survey conducted by Archway Health – a Boston-based firm specializing in managing bundled payments programs – participation in bundled payments has improved the quality of care, and anticipation and preparation for new programs remains high. The survey assessed the perceptions and efficacy of bundled payments ahead of the expected announcement of a new bundled payments program from the Centers for Medicare and Medicaid Services (CMS).

The survey results are based on responses from 70 participants across the U.S. The participants, which included executives, administrators and clinicians, represented the continuum of healthcare from hospitals, specialty care, post-acute facilities and home health care.

Key findings from Archway’s survey indicate the impact of bundled payments:

  • 75% of respondents say involvement in these programs has improved quality of care, whether it lowered costs or not.
  • 63% of respondents say bundled payments has both improved quality and lowered cost.
  • The most prominent reason for not participating in bundled payments was the potential administrative burden. No respondents cited a limited return on investment as a reason for not participating.

“It was great to get such a strong and positive response that confirms what we’re seeing with our provider partners – bundled payments work,” said Dave Terry, founder and CEO of Archway Health. “Bundled payments will continue to play a major role in healthcare as we move from volume to value, especially as we move toward models that encourage efficiency and improvements in care quality. Archway is dedicated to helping specialists succeed in all of these programs as they continue to grow.”

Other findings from the survey indicate healthcare professionals’ attitudes towards bundled payments:

  • As CMS is expected to release a second generation of Bundled Payments for Care Improvement (BPCI), 75% of respondents are “definitely” or “probably” planning to participate.
  • When it comes to bundled payments, 25% of healthcare professionals say they are “100% ready” to implement them, while 56% are “getting prepared” or “just started the process” with more to do.

“It’s great to see that healthcare professionals want to participate in bundled payments and are actively preparing to do so,” said Keely Macmillan, general manager of BPCI for Archway Health. “Bundled payments offer clinicians and healthcare professionals the opportunity to take control of the entire care process and ensure patients achieve the best outcomes in a cost-efficient manner.”

Since its inception in 2014, Archway Health has been active and solely focused on bundled payments. Specialists and providers partner with Archway to receive guidance on how to navigate every step of bundled payments participation.

To learn more about bundled payments, the survey, the anticipated new CMS program and how it impacts providers, please contact info@archwayha.com.

About Archway Health

Archway Health, founded in 2014 and built on a deep foundation of healthcare payment reform expertise, works with providers to design and execute care and risk management initiatives that drive success in bundled payment programs. Archway is currently working with leading healthcare providers participating in the CMS BPCI and OCM programs, as well as with commercial payers operating bundled payment initiatives. To support these programs, Archway works with providers to analyze their opportunities and risks and to deploy its comprehensive platform of analytics, patient tracking tools, and advisory services to ensure their success in bundled payments. For more information, please visit www.archwayhealth.com.

Contacts

For Archway Health Olivia Armstrong, 781-924-6714 oarmstrong@hencove.com

The Next Generation of BPCI: What We Know So Far

The next generation of Bundled Payments for Care Improvement (BPCI) is on its way. Though an official release date remains to be seen, the Centers for Medicare & Medicaid Services (CMS) does expect to announce the new model before the end of the summer. As we await the details of the coming voluntary model, results from the first generation of the BPCI program provide us clues into what the new program might look like. BPCI Success  

The original BPCI program will end in September 2018. Currently, there are 1,191 participants in BPCI Models 2 - 4, according to the Bundled Payments for Care Episode Analytic file updated April 6, 2017; an additional 38 Awardees participated in BPCI Model 1 which concluded on March 31, 2016. The episode groups with the greatest participation under BPCI are lower joint replacements, sepsis, congestive heart failure, and pneumonia and other infections. Orthopedic specialists participating in these episodes have realized on average $864 in savings per clinical episode.

Though these savings are significant, the anecdotal information that CMS has gathered indicates that many providers have saved even more. Taking a look at our own slate of specialists, Archway has helped them earn more than $2,000 in additional revenue per case.

The Next Generation  

Without a doubt, CMS’ new BPCI program will build on the success of the original program. Logistically speaking, CMS has confirmed that it will continue to offer a voluntary bundled payment program that qualifies as an Advanced Alternative Payment Model (APM) under MACRA’s Quality Payment Program.

Additionally, the next generation of BPCI is being designed by both an internal CMS team and participating healthcare providers. CMS has conducted many interviews with current BPCI participants to gain insight for fine-tuning the next iteration. Providers have expressed they would like to see:

  • More inclusive pricing model: Providers want to see a modified pricing model that creates opportunities for both highly efficient and less efficient providers.
  • Championing specialists: This round of BPCI will place more emphasis on specialty physicians as episode initiators.
  • Changes in how the trend factor is applied: Providers expressed concern with the current methodology of how CMS adjusts target prices for BPCI participants each quarter.
  • Better-assigned National Provider Identifiers (NPI): CMS has had challenges accurately attributing patients to participant physician groups, particularly hospitalists.
  • Managing risk upstream: Rather than only working with third-party conveners or becoming conveners themselves, providers would like to work with payers and re-insurance companies to help manage risk.

Given the new BPCI model will be a voluntary model like its predecessor, we expect these matters will be addressed in the coming BPCI program so as to entice participation.

The Timeline

While the exact release date of the new BPCI model is not known, CMS does expect an announcement soon. This coincides with a BPCI report expected to be released on how the program has done so far, including stratifying by specific clinical episodes, not just episode groups.

Though the last BPCI was not officially rolled out until three years after its announcement in 2011, we also expect that the next generation will go live in mid 2018 to to coincide with the sunsetting of the BPCI program in September.  This is important for two reasons: it enables participating providers to continue in the program, and it creates an opportunity for specialists to qualify for the Advanced APM payment track in Year 2 MACRA and avoid the more punitive MIPS track.

 In the Meantime 

Though the new BPCI model has not yet been announced, providers, particularly specialists, should consider preparing for participation in this new bundled payment model. At Archway, bundled payments are all we do, and we are committed to helping healthcare providers succeed in the next generation of BPCI.

In a free, half-hour consultation, we can help healthcare providers, and specialists in particular, learn more about the imminent BPCI program, and find potential savings in a provider-specific Bundled Payment Scorecard. To learn more, we welcome you to contact our team at info@archwayha.com.

Recent Cancellation of Mandatory Payment Models Surprises

Archway Health CEO Dave Terry was recently quoted in McKnight's article titled "CMS surprises-and doesn't- with pay model changes" on the elimination of previously mandatory payment models. “We thought [the models] would probably be switched from mandatory to voluntary,” he said. “But we didn't think they would be eliminated, just because there is demand for these programs on the voluntary side.” Although the complete elimination of the program was a surprise to many, experts predicted a shift from mandatory participation to voluntary. As we previously highlighted in this blog post, our team at Archway believes that this news is promising for the future of voluntary programs.

Read the full article on McKnight's.

Archway Health Bolsters Team Ahead of Expected New Bundled Payments Programs from CMS

Additions of General Manager of BPCI, Director of Operations, Senior Client Manager, and Client Manager Bring a Broad Scope of Healthcare Experience WATERTOWN, Mass., – September 7, 2017 – With an expected announcement of a new bundled payments program from the Centers for Medicare and Medicaid Services (CMS), Archway Health has hired four new team members to bolster and expand the organization’s capabilities, operations, and client services. Currently, Archway is a leading partner to specialists, hospitals, conveners and other specialty healthcare providers in CMS’s Bundled Payments for Care Improvement (BPCI); it is believed a new program will be announced within the next month.

Keely Macmillan joins as general manager of BPCI, a new position for the company, and will oversee the next generation program. In addition, Archway hired Tim Williams, director of operations; Jacqueline DaSilva, senior client manager; and Jackie Jacobs, client manager.

“We fully expect and are prepared for the next generation of Medicare bundled payment programs, and have added to our team to help providers prepare as well,” said Dave Terry, founder and CEO. “At Archway, we are committed to building the premier bundled payments team, and I am excited to bring on board team members that have the deep experience and expertise in this space to help improve our organization today and better position us for tomorrow.”

Previously, Macmillan was manager of government payment policy at Partners HealthCare, the largest health system in Massachusetts, where she managed public payer financial forecasting and led the government payment policy team in the analysis of performance-based reimbursement models. Among other topics, Macmillan is recognized as an expert in alternative payment models including bundled payments, ACOs, value-based purchasing, and MACRA’s Quality Payment Program. Macmillan earned a master’s degree from the Harvard T.H. Chan School of Public Health and a Bachelor of Science from Yale University.

In addition to Macmillan, Williams, DaSilva, and Jacobs all joined the company in new positions.

Williams is an accomplished strategist in the healthcare technology industry, with nearly 10 years of experience in value-based healthcare. He will join Archway as director of operations, while also serving as product manager for Carelink, Archway’s patient-tracking platform. Previously, Williams drove care coordination efforts at MaineHealth ACO, leading development of a strategic plan for population health management. He also held senior strategy positions at RxAnte and Health Dialog. He earned an MBA from Johnson Graduate School of Management at Cornell University and a Bachelor of Arts in Managerial Economics from Colby College.

DaSilva has a diverse background in healthcare consulting, management and client relations. As senior client manager, she will guide providers in their bundled payment program design, setup and ongoing management. Previously, DaSilva was director of quality improvement at Kindred Hospital, and also was performance improvement manager with Cape Cod Healthcare’s ACO. She earned a Bachelor of Arts from Bryn Mawr College and a Bachelor of Science in Nursing from the Massachusetts General Hospital Institute of Health Care Professional School of Nursing.

Jacobs has a range of healthcare and client management experience in both commercial and nonprofit settings. As client manager, she will assist bundled payment participants in navigating their program. Previously, Jacobs managed patient accounts on a national scale at American Renal Associates, in addition to working with A Little Easier Recovery nonprofit organization for cancer patients. She earned a Bachelor of Science in Public Health from the University of Massachusetts Amherst.

About Archway Health Archway Health, founded in 2014 and built on a deep foundation of healthcare payment reform expertise, works with providers to design and execute care and risk management programs that drive success in bundled payment programs. Archway is currently working with leading healthcare providers participating in the CMS BPCI and OCM programs, as well as with commercial payers operating bundled payment initiatives. To support these programs, Archway works with providers to analyze their opportunities and risks and to deploy its comprehensive platform of analytics, patient tracking tools, and advisory services to ensure their success in bundled payments. For more information, please visit www.archwayhealth.com

 

Media Contact: Olivia Armstrong 781.924.6714 oarmstrong@hencove.com

Navigating MACRA: Comparing MIPS Versus APM for Specialists

January 1, 2017 marked the start of the first year of the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP). More than halfway through the first performance year, many specialists are still trying to navigate participation, and one of the main questions is which payment track to pursue. MACRA, which was signed into law in 2015, was established to accelerate efforts to reimburse clinicians based on quality of care, instead of volume of care. To comply with the law, physicians must enter one of the two QPP value-based payment tracks: MIPS or Advanced APMs.

Track 1: MIPS

Merit-Based Incentive Payment System (MIPS) is a payment system under which physicians receive positive, negative, or neutral payment adjustments for their performance in selected quality measures. The track requires reporting in four performance categories: Quality, Advancing Care Information through Health Information Technology, Clinical Practice Improvement Activities, and Resource Use. MIPS must be budget-neutral to Medicare on an annual basis, such that bonuses paid to relatively high performing physicians must be equally offset by penalties applied to relatively low performing physicians.

Track 2: Advanced APMs

The second track is Advanced Alternative Payment Models (APMs). For most specialists, participation in the upcoming next generation of Bundled Payments for Care Improvement (BPCI) will be the first opportunity to qualify for the Advanced APMs track. Participants who have sufficient revenue or patients in an Advanced APM will receive an automatic 5% payment bonus with the opportunity to earn even more if they achieve savings targets under BPCI.

The Next Opportunity For Track 2: BPCI Advanced

It is important to note the two-year lag under both QPP payment tracks such that clinician reimbursement in 2019, MACRA’s first payment year, is based on performance during 2017.  To qualify for the Advanced APMs track in payment year 2020, providers must begin participating in an Advanced APM in 2018.

With the MACRA QPP’s second payment year fast approaching, providers should think strategically about which track they should pursue. Of the two tracks, we at Archway believe the Advanced APM track is more advantageous for specialty-focused providers. While physicians are forced to accept downside risk under an APM arrangement, there are clear benefits: better access to performance data through the Center for Medicare & Medicaid Innovation (CMMI) to implement care improvement initiatives, the opportunity to receive a 5% lump sum bonus under MACRA (regardless of performance in the Advanced APM) and avoidance of downside risk and additional quality reporting requirements under MIPS. Conversely, MIPS offers limited upside potential due to the forced-ranking mechanism applied by CMS to achieve budget neutrality, as well as a diminished incentive pool resulting from broadened MIPS exclusionary criteria.

At Archway, we believe qualifying for the Advanced APMs track though participation in the next generation BPCI program is not only the better option under MACRA’s QPP, it’s a better business solution. Bundled payments can help grow your practice, and Archway is the partner to help you navigate these bundled payment programs.

Voluntary Participation in Bundled Payments Will Continue after Cancellation of Mandatory Programs

In the article "Voluntary participation in bundled payments will continue after CMS cancels mandatory initiatives, experts say," Healthcare Finance interviews experts for their thoughts on the recent news of the proposed rule by CMS to cancel the episode payment models and the cardiac rehabilitation incentive payment model. Experts interviewed by Healthcare Finance, including Archway Health CEO Dave Terry, "believe the switch from mandatory to voluntary bundles is positive for providers and will not affect participation or the movement to value-based care."

Eliminating the mandatory models gives CMS greater flexibility to design and test innovations that will improve quality and care coordination across the inpatient and post-acute-care spectrum, the agency said in the proposed rule.

Read the full article from Healthcare Finance.

Cancellation of Mandatory Bundles Paves the Way for Voluntary Success

This week, the Centers for Medicare & Medicaid Services (CMS) announced it will cancel its mandatory cardiac and orthopedic Episode Payment Models (EPM), in addition to scaling back the Comprehensive Care for Joint Replacement (CJR) model. While the news has left some questioning the future of value-based care, the cancellation of these mandatory bundled payment programs is a favorable indication of the future of voluntary reimbursement programs.   The recent cancellation of mandatory bundles has been brewing for some time. Prior to the cancellations, Tom Price, Secretary of the U.S. Department of Health and Human Services delayed the effective start date of EPM, and openly criticized the mandated programs. And while it may seem that bundled payments have been through the fire in just a few short days, two voluntary models that have seen much success among providers have emerged unscathed: Bundled Payments for Care Improvement (BPCI) initiative and Oncology Care Model (OCM).

Even when mandated programs were in place, hospitals and other stakeholders were pressing for voluntary initiatives. Results from the voluntary programs have shown greater engagement and increased savings among providers who are eager to improve quality and reduce costs in a pressured healthcare environment. As success of the voluntary models continues, we expect the adoption of these programs will only continue to grow.

At Archway, we have a rather unique opinion on the recent news and the mandatory versus voluntary debate. As a bundled payment company, one would likely assume we are in favor of mandatory bundled payment participation. In fact, we believe the best approach for bundled payment programs is to allow voluntary participation.

While we were initially excited about the CJR and EPM programs that included mandatory participation for certain areas and hospitals, we have concluded over the past two years that voluntary programs will have a bigger and more rapid impact on the shift from volume to value.

Even better news in the announcement this week is the clear indication that CMS is moving full speed ahead with a new voluntary bundled payment program that will allow hospitals, specialists and post-acute providers to serve as Episode Initiators. We view this as a very positive development for providers who missed the last voluntary open enrollment period in early 2014.  This program will also enable CMS to offer an opportunity for specialists to participate in a MACRA qualifying Advanced Alternative Payment Model (APM) in 2018.

As CMS prepares to launch the next generation of BPCI in the coming weeks, we’ve actively advocated for the program to be voluntary. There are three main reasons why we believe voluntary bundled payment programs will be more successful in this transition:

The first is the willingness of providers to commit to payment reform. Because they have signed up, provider organizations participating in the voluntary programs are more engaged and motivated to change processes, improve care, and reduce costs. As a result, the improvements are more significant and the adoption occurs more rapidly.

The second is that voluntary programs don’t have to appeal to all providers. In order to make mandatory programs palatable to reluctant participants, the rules tend to be watered down compared to the rules within the voluntary programs. As a result, there is less urgency to change behavior, and the improvements in care and cost are not as substantial.

Finally, we have seen many specialty groups, hospitals and post-acute providers achieve significant success in these voluntary initiatives.  In the programs we have helped manage, we have seen outcomes improve, patients return home faster, and significant savings earned by both CMS and the Episode Initiating providers.

Even in losing these mandatory bundled payment programs, CMS continues to push the industry toward value. By having voluntary participants show the benefits and significant improvements from bundle payment programs, more providers will eventually want to participate, and we are confident we will see a more impactful shift in payment reform.