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.