Advice for Bundled Payments: Bringing Clinical Care into the Conversation

Clinical care is an essential aspect of any successful bundled payment program, and participating providers should work to include their clinicians. In the second installment of our Advice for Bundled Payments blog series, we sat down with two members of our clinical care team; Kemi Okunade, Vice President of Clinical Services, and Aimée Bailey, Senior Director of Care Operations. We asked Kemi and Aimée how providers can engage clinicians in their bundled payment program and what to consider when starting a new program.

Q: What unique insights can clinicians offer when providers are evaluating bundled payment programs?

A: It is essential to engage clinicians from the beginning and make sure that they are involved in the decision for your organization to take part in the program. Practices that are successful in bundled payment programs are usually those that take care redesign seriously and implement processes to identify and address patient needs throughout the episode. Creating a care coordination program that follows beneficiaries throughout the episode, connecting patients to the care they need when they need it, is an important aspect of any bundled payment program. Clinicians are well-equipped to provide valuable insights on how best to design it.

It’s also important to note that while there are general strategies, such as care coordination, that can be applied to all episodes in bundled payment programs, there are condition-specific nuances that require the expertise of practitioners caring for these populations. The clinical team must review where the variation in practice is and determine strategies on how the care delivered can be standardized to reduce variation. Bundled payment programs are not purely “administrative” or “financial” programs, and they shouldn’t be run as such by excluding clinicians.

Q: What advice would you share with practices that are on the fence about joining BPCI Advanced?

A: Taking on a new program may seem overwhelming, but it’s important to remember that the U.S. is moving towards an era in which these payment models will be the norm. Practices would be wise to begin implementing systems to support value-based healthcare delivery that will allow them to remain competitive in this changing healthcare market.

While BPCI-A is targeted specifically at the Medicare population, the basic principles of ensuring that patients receive the right care, at the right time, in the right setting, apply across all value-based payment programs. Investments made in one program, such as improved care coordination, will likely complement other programs. There can also be significant overlap in the quality metrics that different programs require providers to track, allowing providers to focus efforts on metrics that are relevant across many of their programs. 

Q: Can you talk about the ways in which providers can engage with staff to get them knowledgeable and on-board with the BPCI-A program? 

A: It is crucial that all staff – clinical and non-clinical – who serve BPCI Advanced beneficiaries are not just aware of the program but are actively engaged if providers want to maximize their success. We encourage providers to convene a small group of champions comprised of clinical, operational and administrative leaders who, in addition to having general oversight of the program, will be responsible for engaging staff of all levels of the organization. This group is responsible for ensuring that all relevant staff members are educated about the program and know what their role is. Wherever appropriate, providers should encourage staff to contribute ideas on what could be improved to maximize success in the programs and should seriously consider those ideas. 

Having the right incentives in place, such as gainsharing arrangements with physicians and other practitioners who initiate episodes, as well as other forms of rewards or recognition for staff who are not involved in episode initiation, can go a long way to secure staff engagement.

Q: In your experience, what’s the one thing that providers miss when first starting out in a bundled payment program? 

A: Providers that maximize their success in bundled payment programs are those that emphasize care redesign with a focus on the needs of their patient population. This usually involves setting up a care management program which identifies and supports patients who are at high risk of utilizing high-cost healthcare settings, because they may be either unable or unaware of how to access the care they need. 

For BPCI Advanced, where the provider is responsible for all healthcare costs associated with the 90-day episode – regardless of whether they are directly related to the anchor procedure or admission – it is important to have a strategy that ensures patients are getting the right care, at the right time, in the right setting.

Want to more advice about bundled payments? Contact a member of our value-based care team with your questions.