In helping providers navigate, manage risk and improve clinical processes in BPCI Advanced, we’ve identified commonalities among the providers that have shown strong early results. For those looking to join the program in Cohort 2, these attributes can serve as a guide or checklist providers can use to prepare for the program:
Believe in value-based care: Organizations succeeding in the program went into it because they are believers in value-based care. CMS is not slowing down its transition from fee-for-service or transference of risk to providers; in fact, the agency is speeding up and planning to release four new mandatory models it announced last year. Successful BPCI Advanced participants see the program as a vehicle for that transition.
Dedicate the appropriate resources: Participants need the right technology and personnel resources supporting the program. This includes executive sponsorship, knowledgeable program managers, dedicated care coordinator(s), physician leadership, and care management and performance analytics tools.
Gain stakeholder buy-in: Along those lines, BPCI Advanced organizations that have done well so far have aligned strategies for success, both among physician leadership and ‘boots on the ground’ administrators and clinicians involved directly in care.
Use historical data: By looking at their past performance data, participants can identify actionable levers. These can lead to finding “low-hanging fruit” opportunities for improvement, such as decreasing post-acute utilization where appropriate.
Set performance goals: Participants need clearly-defined goals and a way to track against them. Examples from our participants include readmission rates, ER rates, post-acute utilization, and more.
Identify patients in the program: Successful groups have a process in place to identify BPCI Advanced patients in real time.
Utilize risk assessment tools: With the right technology and clinical assessment tools, participants can develop patient-specific care pathways.
Establish a preferred provider network: By working with a select group of post-acute providers and collaborating with them on success metrics, BPCI Advanced participants can manage the continuum of care and help patients stay on track with their care plan.
Redesign care models: The success of BPCI Advanced hinges on implementing care model redesign, including the hospital discharge process and other care delivery aspects.
Educate patients: A primary goal of bundled payment programs like BPCI Advanced is to improve care outcomes and help patients get better and get home faster. Successful practices are committed to engaging patients in their care, educating patients about the program and setting expectations for follow-up visits.
One attribute that successful BPCI Advanced participants don’t necessarily have is experience in value-based care. Bundled payment programs are ‘learn by doing’ endeavors that don’t require prior experience to be successful. We’ve seen providers both with and without prior experience in value-based care find success.
Many of the attributes of successful BPCI Advanced participants are “nature versus nurture” – some are inherent to a practice’s culture, while others can be learned. With both, Archway can help.
The last open window for providers to join BPCI Advanced is coming this month. We encourage providers interested in the program to submit the non-binding application, get their data, and evaluate the program risk-free.
From application to implementation, Archway can help you determine if and how your practice can find success in the program.