6 Steps to Bundled Payment Success: Opportunity Assessment

6 Steps to Success in Bundled Payment ProgramsProviders who elect or are mandated to participate in Medicare bundled payment programs frequently say that one of the biggest benefits is access to broader data about their patients. While they have had access to their own billing, claims, and EMR data, most providers have had little insight into what happens to their patients once they leave their facility or practice. That initial excitement is often tempered when they get the data. A typical Medicare data feed includes dozens of files for different claim types. The files contain hundreds of megabytes, or even gigabytes, of raw claims data. There are literally hundreds of different fields, some useful, some not so useful. Most providers find themselves struggling to even know what questions to ask from the data, let alone how to use the data to answer those questions.

Archway works with our clients to build baseline assessments from these files that answer a wide range of questions including comparative utilization, cost, quality, and process of patient care. Our goal is to answer our customers’ questions, not drown them in a sea of data and mountain of reports. Archway analysis is information rich. We have terabytes of data, but our customers don’t need data, they need answers.

Our team of analysts has decades of experience turning claims data into meaningful, trustworthy information. They know what fields are usually trustworthy and what fields are often unreliable. They have algorithms to build those claims into episodes of care. They know how to stratify the data geographically, and they have access to much larger datasets for comparative analysis like the 100% “sample” of Medicare Part A claims and the 5% Sample of Part B claims.

Focusing a Baseline Assessment

The content of a baseline assessment varies among bundled payment programs. In voluntary programs like the Bundle Payments for Care Improvement (BPCI) initiative and Oncology Care Model (OCM), we start with an assessment of the price or prices that you receive. How do your prices compare with other providers? Does your price have room for catastrophic cases? Is the price sufficient to give you a reasonable chance of success in the program? There may be other choices related to price. For instance, in BPCI, you can choose a “risk track” and an episode length. Other programs, particularly the Comprehensive Care for Joint Replacement (CJR), are mandatory. When providers cannot decide if they want to participate, a pricing analysis may still be important for expectation setting, but only as a part of a broader analysis that considers random risk and volatility in these programs.

While price is a start, we focus on helping our customers think beyond the physical or virtual walls of their facility or practice as part of the preparation for participation in bundled payment programs. Often, we find that providers have little idea of what happens to their patients once they leave the hospital. How does the total cost of the episode get allocated among different providers? Is the allocation in your episodes typical or different from other providers in your areas and from top providers in the country? What is the role of skilled nursing (and how do the SNFs that you use compare both on your patients but also in the larger Part A claims dataset)?

Throughout the baseline analysis, we focus on two related goals, helping our customers understand what happens in the episodes more broadly and helping them prioritize their interventions. Archway’s experience in bundled payment programs is that providers who try to solve too many problems at once generally underperform providers who decide to focus on a few opportunities and address them very well. Therefore, we try to help our customers set priorities through our baseline assessment. Descriptive and comparative analyses are tools that enable our customers to think through and prioritize their interventions.