Q&A with CEO of Archway Health, Dave Terry

We sat down with our CEO and Co-Founder, Dave Terry, to pick his brain about bundled payments and why he got into this line of work. 

Let's start with the industry. What role do you see bundled payments playing in the future of healthcare?

Bundled payments are a key part of the movement toward value-based healthcare. If you think about ACOs, they are really focused on helping primary care physicians take control over the patient process and manage the health of the population they care for. But, bundled payments are focused on specialists. That's creating opportunity and accountability for specialists to improve the process, improve outcomes and reduce costs for their patient population. 

We like to think of it this way: population health is about meeting the basic needs of a broad population, and bundled payments are about what happens when the patient gets sick and needs more specialty care. Bundled payments help us to proactively manage that process and episode for a patient that has a specific condition, put the appropriate specialist in charge of that process, and help that patient get better and get back home as quickly and safely as possible. It also helps them work with the best providers along the care continuum, improve outcomes and reduce costs. 

Why do bundled payments work? Is it truly a win for all involved parties?

We do think bundled payments can create a win-win for all parties involved. From a patient perspective, it's certainly a win. When a patient has a specialty need, whether it's a hip replacement, spine surgery, or even a medical condition, it's best for a specialist who knows the most about that procedure being responsible for the patient's care. In a bundle, it creates new incentives and opportunities for the specialist to engage with that patient over the full course of the treatment, not just while they are doing the procedure or when the patient is in the office. We've seen better outcomes when the specialists are fully engaged throughout the full treatment period - patients get home faster, they ambulate faster, and they have a better experience. 

We think this approach is also better for the specialist for a couple of reasons. There's increased satisfaction and autonomy over the process - not just performing the procedure but helping to see patients get better and staying with them through that process. You're understanding what's going on in the rehab setting, understanding what's really needed for the patient, and interacting with those patients. So, that autonomy and satisfaction increase among the specialists who participate in these programs. There's also financial reward for the specialists. When specialists do well in these programs, they can earn more revenue. So, yes, there's more engagement with the patients, and the revenue goes up as well. 

From the payor's perspective, this greater engagement and greater interaction between the specialist and the patient translates into decreased overall costs. The patient gets home faster. They utilize less nursing home services. Physical therapy is more efficient. They ambulate faster. They get better faster. And, readmissions go down. So, we've seen dramatic decreases in costs from the payor's perspective. 

Bundled payments are truly a win for all parties - patients, providers, and payors.

What advice would you share with practices on the fence about BPCI Advanced?

The first and most important piece of advice is to make sure you get on an application for the BPCI Advanced program by March 12. It's a non-binding application process from CMS. There's no commitment yet, but it gives you a lot of value. 

First, it gives you the option to participate in the program when the model goes live October 1. And, second, maybe more importantly, it gives you access to your data. You'll get pricing information and four years of historical claims data. And, you'll get to do an informed assessment of what the program looks like for you and what the opportunities for improvement are to earn savings. Then, in the summer, you can decide if you want to participate or not. But, if you don't get on that application by March 12, you won't be able to get that information, and you won't be able to make an informed decision. Providers ask us if it's too late to begin the application, even now. From our perspective, it's not too late, and providers shouldn't hesitate to get started.

What drew you into healthcare as a profession?

I got into healthcare right out of college in the early '90s. I was interested in public policy and politics. But, healthcare has always been interesting to explore, particularly how we pay for healthcare and how we organize the system. It's always been a fascinating issue for me. Fortunately, I've been able to spend most of my career working on different reimbursement models and care and risk management programs like ACOs, capitation, pay-for-performance, and now bundled payments. 

It just seems like there is so much opportunity for improvement, and it's a very important issue. And, I've always found it an exciting space to work in. My goal is to help find ways to make some improvements. We think bundled payments are an innovation in the payment world that makes a big impact on those improvements. It improves care. It improves the process both for the patients and the physicians. 

Review of CMS' Open Door Forum

Sign up for our webinar today at 2 pm EST to learn more

Yesterday, CMS held its first Open Door Forum about the recently announced new voluntary program, BPCI Advanced. We joined the Forum and are sharing our five key takeaways from the event with you. Archway will be providing additional detail during our upcoming webinar on Wednesday, Jan. 31 at 2 pm EST.

1. Public interest is very strong.
CMS received more than 600 questions about BPCI Advanced leading up to the Open Door Forum.

2. In the next few weeks, CMS will release details on the following program components:   
Target Pricing: During the Open Door Forum, CMS outlined the intricacies of the updated target pricing methodology, which will no longer be based solely on a provider’s historical costs. New adjustments will incorporate:

  • Patient comorbidities through the use of HCC risk factors
  • Peer group characteristics based on the 9 US Census Regions
  • Peer Adjusted Trend (PAT) Factor to replace the BPCI Trend Factor
  • Regression model for added risk adjustments

CMS’s incorporation of HCC risk factors and regression modeling resonates with the pricing methodology for CMS’ cancer bundle program, the Oncology Care Model, in which Archway has deep experience.

CMS also announced it will adjust Major Joint Replacement of the Lower Extremity (MJRLE) target prices for fracture status, and will soon release more detail on how Total Knee Arthroplasty in the hospital outpatient setting will impact target prices for the inpatient MJRLE bundle. Archway was excited to learn that CMS will release detailed specifications about the new target pricing methodology in the next few weeks; we will provide our insights on the new methodology shortly after its release. 

Composite Quality Score (CQS): CMS announced its plan to provide more detail on how the CQS will be calculated for program participants in the next few weeks.

3. The most common questions CMS received were related to CJR program hierarchy.
CMS reiterated that CJR takes precedence over BPCI Advanced for the assignment of MJRLE bundles.

4. Outpatient bundle anchor setting.
CMS confirmed that OP bundles can only be triggered in the hospital outpatient department setting.

5. Baseline period.
CMS announced that the baseline period used to calculate benchmark costs will be a four-year period from January 1, 2013 to December 31, 2016. Applicants who request data through the application process will receive three years of data, January 1, 2014 to December 31, 2016. In preparation of this program, Archway has purchased more than five years of Medicare claims data, including 2013, and can help providers understand their performance during the full, four-year baseline period.

Lastly, CMS has scheduled a second Open Door Forum, to be held on Thursday, Feb. 15 from 12 pm to 1 pm EST. Registration is now open.

To learn more about BPCI Advanced and evaluate your opportunity in the program, please contact Archway today.

Secure Your Option to Participate in BPCI Advanced

After months of waiting, the Centers for Medicare & Medicaid Services (CMS) officially announced its next generation of bundled payments on January 9, 2018: BPCI Advanced. And, just a few days later, on January 11, open enrollment began for the agency’s most innovative bundled payment program yet. 

Now, many providers are left asking, “Is BPCI Advanced right for me?” 

With less than two months before open enrollment closes, and critical details still to come, the important first step providers can take toward BPCI Advanced is to secure their option to participate. With CMS’ non-binding application process, providers can, in effect, ‘raise their hands’ for participation by submitting some basic information to CMS by the March 12th deadline.  

So, why secure your option to participate now? 

  1. Power to decide: Engaging CMS now gives you the power to decide later. Submitting a non-binding application allows you to receive your cost and quality data and target prices to evaluate if the program is right for you. Once open enrollment closes, there will be no other opportunities to participate in BPCI Advanced until 2020.
  2. Revenue to gain: Practices working with Archway Health in the first generation of BPCI generated as much as $3,000 in additional revenue per episode of care.  Participation in BPCI Advanced will also allow providers to earn bonuses under MACRA’s Advanced APM track and avoid downside risk under MIPS.  
  3. Nothing to lose: Keeping your options open for participation in BPCI Advanced does not bind you to participation. It lets the agency know you that you are considering the program. The binding contract is not due until August.

We’re making it sound simple, but in reality, getting started with BPCI Advanced isn’t easy. That’s why we’re offering practices to partner with us. We’re a BPCI convener, and you can simply sign our non-binding Good Faith Agreement, and we’ll handle the application process and data processing for you. We’ll help you apply for and evaluate the program in a free, unbiased manner. There’s no pressure to commit to us, or CMS, now, but we want to help you keep your options open. 

When you sign our Good Faith Agreement, you’ll gain access to Archway Academy, our online education platform offering tools and tips to succeed in BPCI Advanced. Archway Academy will help you decide if BPCI Advanced is right for you. Archway will also be offering weekly webinars to provide updates on BPCI Advanced as more information is released, as well as to talk more about the Academy. Sign up for our next webinar on Thursday, January 18 at 2:30 p.m. EST. 

Take the first step now, and secure your option to participate in BPCI Advanced. Contact us today for assistance with beginning the BPCI Advanced application process.  

Bundled Payment Model Creates Opportunities for Providers

On Tuesday, January 9, 2018, CMS announced the next generation of BPCI. Yesterday, January 10, CMS released additional information about BPCI Advanced that we want to share with you.

CMS identified all 29 inpatient bundles, including 10 orthopedic bundles and eight cardiovascular bundles, and a new liver bundle. CMS also identified three outpatient bundles: Cardiac Defibrillator; Back & Neck, except Spinal Fusion; and Percutaneous Coronary Intervention (PCI).
We are excited by these new bundles, which will engage a broader audience and energize new thinking around cost savings. As CMS noted previously, PCI alone generates $10 billion in aggregate Medicare spending annually. Clearly, these bundles collectively represent a sizeable segment of the healthcare market.
In addition to the new bundles, CMS announced 20 bundles will be removed that were previously included in BPCI, including chest pain and diabetes, that had not generated meaningful cost savings. Ultimately, the refinement of the final bundles reflects CMS’ continued evolution of bundled payment models.
In BCPI Advanced, CMS will also introduce an updated Physician Group Practice (PGP) pricing model that incorporates PGP-specific adjustments, and a more sophisticated methodology for setting benchmark prices that incorporate relative efficiency adjustments and regional spending trends. Additionally, CMS will expand bundle definitions to include costs related to hospice care and pre-anchor ER care. Once all of the program details have been released, we will share our perspective on what this means for practices.

You can find the list of bundles here.

We will be sharing a lot more information on a webinar, “BPCI Advanced 101” on Friday, 1/12 at 3 pm EST. On the webinar, we’ll also provide an overview of Archway Academy,  an online learning platform dedicated to helping providers who are working with us to better understand and prepare for BPCI-Advanced. 

Can’t attend? Contact us directly and we’ll provide a link to the recording. 

We look forward to working with you soon.

Breaking News: CMS Announces BPCI Advanced

This evening, CMS announced the next generation of BPCI. Open enrollment for the new payment model, BPCI Advanced, begins Thursday, January 11, 2018. Here's our early perspective on the new program.

In this evening's press release, CMS shared some of the program’s characteristics:

  • Voluntary model, which qualifies as an Advanced APM under MACRA
  • A single retrospective bundled payment and one risk track, with a 90-day Clinical Episode duration
  • 29 inpatient bundles anchored by 105 MS-DRGs
  • 3 new outpatient bundles identified by 30 HCPCS codes 
  • Bundles include hip/knee replacement, CABG, AMI, PCI, Cardiac defibrillator, and back and neck procedures except spinal fusion
  • Payment is tied to performance on quality measures
  • Preliminary Target Prices are provided in advance of the performance period 
  • CMS will only release data to those who submit non-binding applications.  
  • The enrollment period will be open for 2 months, ending on March 12th.
  • The program will start on 10/1/18 and will run for 5 years
  • There will be one other start date option on 1/1/20

From our perspective, BPCI Advanced aligns with many of our expectations, but also has elements which we are still vetting. Here is our preliminary take:

  • What we’re encouraged by: The addition of OP bundles; A PGP Episode Initiator option with an updated PGP pricing model; CMS will now provide 20% stop loss at the Episode Initiator level.
  • What we’re concerned about: Unlike the original BPCI program, BPCI Advanced does not appear to have an option for post-acute providers to be Episode Initiators; BPCI Advanced won’t qualify providers for the Advanced APMs payment track until MACRA Year 3, despite a performance period in 2018; BPCI Advanced will exclude beneficiaries aligned to Next Generation ACO or MSSP Track 3.
  • What we’re still waiting for more detail on: Episode definitions; the target pricing methodology and baseline period; and how the Composite Quality Score (CQS) Adjustment Amount is calculated.

We’ve spent the evening reviewing a variety of materials and information CMS has provided, including:

  • Participant eligibility for non-conveners and conveners
  • Model timeline and roadmap
  • Definition of clinical episodes 
  • List of quality measures 
  • Details on application process
  • Application materials

There’s a lot to digest. Rest assured, we have helped all of our practice partners achieve success in BPCI and are ready to help you assess, and, if appropriate, enroll in BPCI-Advanced.

We will be sharing a lot more information on a webinar, “BPCI Advanced 101” on Friday, 1/12 at 3 pm EST. On the webinar, we’ll also give an overview of Archway Academy,  an online learning platform dedicated to helping providers who are working with us to better understand and prepare for BPCI-Advanced. 

Can’t attend? Contact us directly and we’ll provide a link to the recording. 

We look forward to working with you soon.