Lessons Learned from BPCI Advanced Cohort 1 Participants

Some of the best insights on bundled payment participation come from those who are already in the program. During a recent webinar “Insights and Lessons Learned with BPCI-A Cohort 1 Participants,” we spoke with three organizations who have been in the BPCI Advanced program since it began in October 2018. 

Darcy Blayney is a process improvement specialist at Bryan Medical Center, a two-campus hospital in Lincoln, NE. Bryan Medical Center is currently live in four bundles: hip and femur procedures, major joint replacement of the lower extremity, AMI and CABG.

Kyle Matthews is the CEO of Phoenix Heart, a cardiovascular group based in Phoenix, AZ. Phoenix Heart includes 14 physicians and a cath lab across six offices and currently participates in inpatient and outpatient PCI bundles.

Jennifer Petrella, the CEO of Citrus Orthopedic & Joint Institute based in Florida. Citrus Orthopedic & Joint Institute is enrolled in BPCI Advanced as a non-convener participant, participating in hip and femur procedures, major joint replacement of the lower extremity and of the upper extremity.

Read on for the lessons Blayney, Matthews, and Petrella shared from their experience in the program—what their expectations were and what surprised them.

1. Bundled payment programs can work for providers of all sizes.

Initially, Phoenix Heart thought that bundled payment programs were only feasible to large organizations with a strong corporate structure and the support of a large team. 

“…when this program came out it was of interest because we thought even a group our size could participate and be successful,” says Matthews. Although they have limited resources, Phoenix Heart has found success by engaging a small team of two who manage the program and work with doctors in addition to having the entire team onboard.

2. The BPCI Advanced program allows you to prepare for future mandatory alternative payment models.

Each speaker emphasized that the likelihood of value-based payments becoming mandatory was a strong motivator in their decision to participate in BPCI-A. Petrella notes, “We actually wish we had got in a little bit before because we knew that the opportunities were going to get harder and harder to reach, so we jumped in as soon as we could when we realized it.” For Bryan Medical Center, the flexibility to choose which bundles they wanted to participate in was also attractive, particularly because they were new to participating in an Advanced Payment Model (APM).

The Center for Medicare & Medicaid Innovation (CMMI) wants 100% of providers participating in upside and downside risk arrangements by 2025, and has announced plans to introduce four new mandatory models. CMS has said that this open window will be the last for BPCI Advanced, which means Cohort 2 is one of the last chances to participate voluntarily in an APM.

3. When evaluating your opportunity, consider all bundles before determining which are right for your organization.

There are many factors to consider when selecting bundles, but it’s valuable to review the data to determine which bundles are the best fit, rather than basing your decision off of assumptions. When discussing their bundle selection process, Darcy says, “We were going to specifically go after some cardiac bundles when this first came out and as we proceeded through that process, we realized that we had opportunity outside of cardiac bundles.”

After a provider has applied to participate in BPCI Advanced, CMS will provide data for all eligible bundles, giving you an opportunity to fully analyze all potential opportunities and make an educated decision when selecting bundles. 

4. BPCI Advanced is a chance to prepare for bundled payment models by learning as you go.

For most, participating in BPCI Advanced involves learning as you go and making ongoing improvements. Phoenix Heart is working to improve its management of inpatient PCI. “We have added some better technology around mobile chart entry on all the cell phones, adding some ability to get more data, but we are missing [the real-time identification of] way too many inpatient PCIs,” says Matthews.

For Bryan Medical Center, the challenge has been managing the relationship with post-acute facilities. “We are really getting our feet wet about managing and co-managing patients in a post-acute facility. That has been one of the areas that we had probably been weaker in and we are beginning to learn more about it in this process.” 

5. Identify and utilize physician champions that already exist within your organization.

Each speaker called out the importance of having a physician champion for the program, but also that it can work differently for each organization. Petrella has been able to directly compare the impact of having a champion at one facility to their other facility that does not. “We are in two different hospitals. In one we have a joint center and a great physician champion and that seems to be going better.” 

For Phoenix Heart, there was so much going on at the practice that a traditional, individual champion was out of reach. “We already had so much going on in our practice that everyone kind of said that we’ll work on this together,” says Matthews. This approach has required more communication and coordination from Matthews but having the entire team’s support overall has worked well.

6. Strong communication with patients, doctors, and post-acute care networks is key.

A repeated token of success in the program from each speaker was tied to the importance of communication. For Bryan Medical Center, establishing nurse navigators, someone who helps assist patients through the 90 days after their anchor stay, has helped to keep a flow of information on the patient’s progress and resulted in a dramatic decrease in readmissions.

Matthews credits much of their success in patient communication to their process of updating physicians weekly on whether their patients have been attributed to the bundle.

In establishing a preferred post-acute care provider network, Citrus Orthopedic & Joint Institute established an open line of communication by meeting with each facility and sharing their expectations for them. By articulating their expectations up-front, Petrella says it “made everyone rise to the occasion.”

Overall, Blayney, Matthews, and Petrella expressed that BPCI Advanced has been a positive experience based in learning more about value-based payment programs. Each expressed a desire to grow their participation, looking to add more bundles in the future and perhaps participate in additional programs.

For those interested in bundled payments, Archway is here to help you get started. “We partnered with Archway early on, and I think that was really key for us,” said Blayney.

To hear more thoughts from Blayney, Matthews, and Petrella, request the June 5th webinar recording.

The deadline to enroll in BPCI Advanced is June 24th. To learn more about submitting a non-binding, risk-free application, contact a member of our value-based care team.