Secure Your Option to Participate in BPCI Advanced

After months of waiting, the Centers for Medicare & Medicaid Services (CMS) officially announced its next generation of bundled payments on January 9, 2018: BPCI Advanced. And, just a few days later, on January 11, open enrollment began for the agency’s most innovative bundled payment program yet. 

Now, many providers are left asking, “Is BPCI Advanced right for me?” 

With less than two months before open enrollment closes, and critical details still to come, the important first step providers can take toward BPCI Advanced is to secure their option to participate. With CMS’ non-binding application process, providers can, in effect, ‘raise their hands’ for participation by submitting some basic information to CMS by the March 12th deadline.  

So, why secure your option to participate now? 

  1. Power to decide: Engaging CMS now gives you the power decide later. Submitting a non-binding application allows you to receive your cost and quality data and target prices to evaluate if the program is right for you. Once open enrollment closes, there will be no other opportunities to participate in BPCI Advanced until 2020.
  2. Revenue to gain: Practices working with Archway Health in the first generation of BPCI generated as much as $3,000 in additional revenue per episode of care.  Participation in BPCI Advanced will also allow providers to earn bonuses under MACRA’s Advanced APM track and avoid downside risk under MIPS.  
  3. Nothing to lose: Keeping your options open for participation in BPCI Advanced does not bind you to participation. It lets the agency know you that you are considering the program. The binding contract is not due until August.

We’re making it sound simple, but in reality, getting started with BPCI Advanced isn’t easy. That’s why we’re offering practices to partner with us. We’re a BPCI convener, and you can simply sign our non-binding Good Faith Agreement, and we’ll handle the application process and data processing for you. We’ll help you apply for and evaluate the program in a free, unbiased manner. There’s no pressure to commit to us, or CMS, now, but we want to help you keep your options open. 

When you sign our Good Faith Agreement, you’ll gain access to Archway Academy, our online education platform offering tools and tips to succeed in BPCI Advanced. Archway Academy will help you decide if BPCI Advanced is right for you. Archway will also be offering weekly webinars to provide updates on BPCI Advanced as more information is released, as well as to talk more about the Academy. Sign up for our next webinar on Thursday, January 18 at 2:30 p.m. EST. 

Take the first step now, and secure your option to participate in BPCI Advanced. Contact us today for assistance with beginning the BPCI Advanced application process.  

Bundled Payment Model Creates Opportunities for Providers

On Tuesday, January 9, 2018, CMS announced the next generation of BPCI. Yesterday, January 10, CMS released additional information about BPCI Advanced that we want to share with you.

CMS identified all 29 inpatient bundles, including 10 orthopedic bundles and eight cardiovascular bundles, and a new liver bundle. CMS also identified three outpatient bundles: Cardiac Defibrillator; Back & Neck, except Spinal Fusion; and Percutaneous Coronary Intervention (PCI).
We are excited by these new bundles, which will engage a broader audience and energize new thinking around cost savings. As CMS noted previously, PCI alone generates $10 billion in aggregate Medicare spending annually. Clearly, these bundles collectively represent a sizeable segment of the healthcare market.
In addition to the new bundles, CMS announced 20 bundles will be removed that were previously included in BPCI, including chest pain and diabetes, that had not generated meaningful cost savings. Ultimately, the refinement of the final bundles reflects CMS’ continued evolution of bundled payment models.
In BCPI Advanced, CMS will also introduce an updated Physician Group Practice (PGP) pricing model that incorporates PGP-specific adjustments, and a more sophisticated methodology for setting benchmark prices that incorporate relative efficiency adjustments and regional spending trends. Additionally, CMS will expand bundle definitions to include costs related to hospice care and pre-anchor ER care. Once all of the program details have been released, we will share our perspective on what this means for practices.

You can find the list of bundles here.

We will be sharing a lot more information on a webinar, “BPCI Advanced 101” on Friday, 1/12 at 3 pm EST. On the webinar, we’ll also provide an overview of Archway Academy,  an online learning platform dedicated to helping providers who are working with us to better understand and prepare for BPCI-Advanced. 

Can’t attend? Contact us directly and we’ll provide a link to the recording. 

We look forward to working with you soon.

Breaking News: CMS Announces BPCI Advanced

This evening, CMS announced the next generation of BPCI. Open enrollment for the new payment model, BPCI Advanced, begins Thursday, January 11, 2018. Here's our early perspective on the new program.

In this evening's press release, CMS shared some of the program’s characteristics:

  • Voluntary model, which qualifies as an Advanced APM under MACRA
  • A single retrospective bundled payment and one risk track, with a 90-day Clinical Episode duration
  • 29 inpatient bundles anchored by 105 MS-DRGs
  • 3 new outpatient bundles identified by 30 HCPCS codes 
  • Bundles include hip/knee replacement, CABG, AMI, PCI, Cardiac defibrillator, and back and neck procedures except spinal fusion
  • Payment is tied to performance on quality measures
  • Preliminary Target Prices are provided in advance of the performance period 
  • CMS will only release data to those who submit non-binding applications.  
  • The enrollment period will be open for 2 months, ending on March 12th.
  • The program will start on 10/1/18 and will run for 5 years
  • There will be one other start date option on 1/1/20

From our perspective, BPCI-Advanced aligns with many of our expectations, but also has elements which we are still vetting. Here is our preliminary take:

  • What we’re encouraged by: The addition of OP bundles; A PGP Episode Initiator option with an updated PGP pricing model; CMS will now provide 20% stop loss at the Episode Initiator level.
  • What we’re concerned about: Unlike the original BPCI program, BPCI Advanced does not appear to have an option for post-acute providers to be Episode Initiators; BPCI Advanced won’t qualify providers for the Advanced APMs payment track until MACRA Year 3, despite a performance period in 2018; BPCI-Advanced will exclude beneficiaries aligned to Next Generation ACO or MSSP Track 3.
  • What we’re still waiting for more detail on: Episode definitions; the target pricing methodology and baseline period; and how the Composite Quality Score (CQS) Adjustment Amount is calculated.

We’ve spent the evening reviewing a variety of materials and information CMS has provided, including:

  • Participant eligibility for non-conveners and conveners
  • Model timeline and roadmap
  • Definition of clinical episodes 
  • List of quality measures 
  • Details on application process
  • Application materials

There’s a lot to digest. Rest assured, we have helped all of our practice partners achieve success in BPCI and are ready to help you assess, and, if appropriate, enroll in BPCI-Advanced.

We will be sharing a lot more information on a webinar, “BPCI Advanced 101” on Friday, 1/12 at 3 pm EST. On the webinar, we’ll also give an overview of Archway Academy,  an online learning platform dedicated to helping providers who are working with us to better understand and prepare for BPCI-Advanced. 

Can’t attend? Contact us directly and we’ll provide a link to the recording. 

We look forward to working with you soon.

Letter to the Editor Featured In Modern Healthcare

Last October, CEO and Co-founder of Archway Health, Dave Terry, wrote a letter to the editor of Modern Healthcare regarding an article the organization published about providers' experiences with bundled payments. The article highlighted the value of bundled payments and growing popularity among surgeons. Dave's letter to the editor urges healthcare professionals to not only examine the value of bundled payments, but also to discover how to maximize effectiveness of the programs. 

Read the full article here

Webinar Highlights: Dr. Jordan Simon explains why his practice joined BPCI

The New York State Society of Orthopedic Surgeons and Archway Health hosted this webinar on December 14th, 2017.  This video highlights some insightful commentary from Dr. Jordan Simon of Northeast Orthopedics and Sports Medicine about why his practice joined the BPCI program and their experience working closely with Archway to design a successful program.

Dave Terry on CMMI'S "New Direction" in HFMA

The Healthcare Financial Management Association (HFMA) recently posted an article written by Archway Health's CEO, Dave Terry, titled "CMMI's 'New Direction' Points to the Future of Bundled Payments." The article discusses the future of value based care and what payment models providers will be able to leverage. He explains that, "With CMS steering the healthcare industry in a new, physician-led direction, providers can stay ahead of payment reform with bundled payment programs. The changes happening at CMS should be heartening to physicians as they will be championed as leaders in the continued shift from fee-to-service to value-based care." Read the full article from HFMA here.

Keely Macmillan Featured in Morning Consult

Although CMS recently announced many changes to current mandatory bundled payment models, industry groups believe that the government will continue to shift the U.S. health care system away from fee-for-service care models and push it towards value-based care. Providers expect that the Trump administration will "take a more conservative approach to bundled payments, with a focus on voluntary participation and fewer regulations."  

Morning Consult interviewed Archway Health's GM of BPCI, Keely Macmillan, on her thoughts of the recent CMS announcements. She said CMS “wanted to clear the way for them to test more voluntary initiatives and that allowed them to have more flexibility in testing new innovations,” and “by pulling back those hospital mandatory programs, they can launch other physician-driven alternative payment models that are voluntary and more inclusive of a broader provider audience.”

Read the full article here

HHS Secretary Nominee Alex Azar Lauds Value-Based Care

Though the tide is still turning in the shift from fee-for-service to value-based care, there is no question that value is the way of the future for healthcare. Health and Human Services (HHS) Secretary nominee, Alex Azar reaffirmed in his confirmation hearing his support of this shift, signifying that the pace of healthcare and payment reform could quicken soon.

Azar expressed that he intends to focus on continuing to transition healthcare from volume to value—one of his top four priorities. Azar says that making the transition to value-based care will “serve as a catalyst for change throughout the healthcare system,” as the Centers for Medicare & Medicaid Services (CMS) sets the tone of payment structure in the industry.

Azar believes this shift will combat payment inefficiencies and allow for healthcare resources to better serve Medicare beneficiaries. If confirmed, Azar will likely continue CMS’s efforts of the past few years towards this approach.

Azar’s belief in value incentives are a reinforcement of the “new direction” that CMS Administrator Seema Verma announced for Center for Medicare & Medicaid Innovation (CMMI) back in September. Azar’s support of furthering the value-based movement is an opportunity to both strengthen the industry as a whole, while increasing operational efficiencies.

As we envision the future, Archway believes that bundled payment programs – one segment of value-based healthcare – will be a driving force in the industry. By rewarding clinicians for improved patient outcomes and lower operating costs, value-based payment structures allow providers to better control care management and patient readmissions.


CMS Poised to Launch New Voluntary Bundled Payment Program

On November 30, 2017, CMS Administrator Seema Verma announced that the new Medicare voluntary bundled payment initiative will be launched soon. Archway couldn’t be more excited.  

In our experience, voluntary, specialist-driven bundled payment models are the best way to improve healthcare for patients, increase autonomy for specialists, and reduce healthcare costs. Proactive specialists participating in these programs can drive real improvement in our healthcare system. With this new initiative around the corner, our goal is to help as many providers as we can to evaluate, enroll, and succeed.

We welcome the opportunity to partner with you to evaluate the program and determine the best path forward for your organization. Success in bundled payments requires a partner you trust. We’re proud of our approach and want to emphasize how our attributes make us the best partner to achieve long term success:

The Archway Team. We have assembled a veteran team of bundled payment experts, healthcare strategists, clinicians, data scientists, technologists and entrepreneurs. Our entire company is completely focused on bundled payments; it’s all we do.   

Transparency & Trust. Our company’s values are: integrity, accessibility, program intelligence and openness. We strive for long-term, trust-based relationships and take pride in achieving continuous improvement through shared learning.

Experience. Our team has been working in bundled payment for more than 10 years. We have been active in all of the Medicare programs since their inceptions and are armed with insights honed from eight reconciliation periods in BPCI.

Continued Success. We have a 100% success rate. Every one of our BPCI partners is improving care for their patients and earning savings in the program. Through transparency and best practice sharing, we continuously learn from and work with our partners to increase savings.  

Comprehensive Platform. We have developed a full-service, internally-built bundled payment platform that includes strategic guidance, web-based data analytics, patient tracking software, gainsharing contracts, risk financing and flexible pricing.

Pricing Flexibility. We can share risk, or we can work on a licensing fee basis. As a provider-centric partner, we are committed to developing the right financial model for your organization.

We are excited to share our plans to launch a complementary training series on the BPCI-Advanced program, engineered to prepare you for success. To participate in this series, please express your interest by contacting us.

Archway Health Featured in McKnight's

Last week, Archway Health CEO, Dave Terry, and GM of BPCI, Keely Macmillan, were featured in an article by McKnight's discussing recent CMS announcements.

On November 30th, 2017 CMS confirmed the cancellation of mandatory bundled payment models for hip fractures and cardiac care, as well as modifications to the Comprehensive Care for Joint Replacement Model. CMS Administrator Seema Verma said, “While CMS continues to believe that bundled payment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on developing different bundled payment models and engaging more providers is the best way to drive health system change while minimizing burden and maintaining access to care.” 

Archway's Keely Macmillan believes that the announcement is “great news for nursing home providers,” and that this, “really clears the way for SNFs to be engaged in these voluntary programs.” 

At Archway Health, we believe that the cancellations of mandatory models pave the way for voluntary success by giving engaged providers the opportunity to innovate around the best way to care for their patients across the full continuum of care.

Read the full article by McKnight's here.

Asking the Right Questions to Achieve Success with OCM

At the recent Association of Community Cancer Centers (ACCC) National Oncology Conference in Nashville and the Community Oncology Alliance (COA) Payer Exchange Summit in Virginia, participants in the Centers for Medicare and Medicaid Services (CMS) Oncology Care Model (OCM) discussed the challenges of implementing such a program. Changes have significantly impacted practices’ organizational culture and staffing, among other areas. Since CMS announced the launch of OCM in 2015, oncology care practices have been working to implement and manage bundled payments to learn how to be more efficient and effective providers. While there has been significant learning along the way, some providers have just started discovering their performance. While challenges still remain, we feel that this voluntary OCM bundled payment program is a step in the right direction.

At Archway, we have identified key questions that we recommend all OCM participants consider to determine what is needed to transform their organization:

-       How is my organization currently doing? What are my organization’s performance goals compared to our target expenditures?

-       What are the key drivers of my organization’s performance? How does my organization compare to other practices?

-       What can we change? What are the key drivers of savings and controlling costs? Where is there room for improvement?

Asking these questions is challenging. And some oncology care specialists will see this as a wakeup call as they realize they have limited data and analytics to provide answers. However, practices that operate without knowledge of their results are working blindly. And, the real answers to these questions will lead you to better care and increased savings.

By participating in the OCM bundled payment program, practices can realize opportunities for reducing cost of care and improving care delivery. Claims data is only valuable once it is transformed into actionable insights. To help OCM practices meaningfully analyze this data and manage a successful program, Archway has developed a proprietary online Oncology Care Analytics Suite™ platform. We help organizations tap into deep analytics to better understand performance results based on quarterly costs and trends, spending and claims details and more. Our SaaS-based tool is designed to evaluate and analyze the raw quarterly data delivered by CMS to help oncologists discover how their practice is performing on a clinical and financial level.

Oncology care practices that are participating in OCM are already on their way to achieving the significant impact of understanding the results of value-based payment initiatives. What is your practice waiting for?

Contact us for more information about how we can help your organization answer the three key questions above.

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.

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.

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

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.


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.


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. 


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 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.