Data & Technology

Bundled Payments in Action: How BPCI Advanced helped Phoenix Heart save a life and gain physician buy-in

Bundled Payments in Action: How BPCI Advanced helped Phoenix Heart save a life and gain physician buy-in

Phoenix Heart PLLC is a cardiology group with six offices in the greater Phoenix area, performing a wide range of services for its patients, including percutaneous coronary intervention (PCI), which it offers as part of the Bundled Payments for Care Improvement (BPCI) Advanced bundled payment program. 

One of the challenges that Phoenix Heart CEO, Kyle Matthews, faced when introducing the BPCI Advanced program to the group, like many other providers we work with, was getting physicians to buy in. A recent case illustrated how the program not only saves money – it can help improve outcomes, and even save lives.

Connected Health Conference: Hardware and Software Solutions for Healthcare

The 2017 Connected Health Conference, held in Boston, MA in October, brought together healthcare leaders to discuss innovations and technologies that are transforming the industry. Some of our own Archway team members attended the conference, which centered around understanding and interacting with digital healthcare and how it relates to patient engagement, data exchange, clinical care, and new research and evidence.

Technology Meets Usability in Hardware

The first step in identifying and managing episodes of care is finding ways to efficiently connect all of a patient’s care team to ensure that all involved providers have access to relevant health records. This type of electronic sharing of health records will improve care coordination and reduce treatment errors. While strides are being made to improve interoperability, healthcare is still lagging when compared to the big technology companies entering the industry, such as Amazon and Google.

As seen at the Connected Health Conference, many technology vendors are trying to solve healthcare providers’ need to efficiently manage patient care. At Archway, we believe there is value in placing the patient in charge of their health data. Patient engagement is key – those who actively participate in their care have better clinical outcomes.

A portable device like an encrypted USB that contains basic health history can be a great tool for patients to bring to their lab appointments, specialists visits, rehab facilities, etc. “Wearable” technology pieces like a glucose-monitoring watch and headphones that monitor pain and discomfort are all able to track health patterns and retain that data for providers to access and use.

With these patient-initiated systems in place, providers are able to view a summary of a patient’s health at each episode of care, creating a consistent stream of valuable health information collected from all parties.

Technology Meets Feasibility in Software  

Using care management software as a means of managing specific patient conditions is also trending in the industry. This brings greater value to providers and an easier way to manage patient care delivery. At Archway, our real-time patient tracking system, Carelink, is a unique tool that can be used to monitor episodes of care. With Carelink, providers can deliver better care to their patients, and see improved collaboration within the care management team.

Carelink allows providers to see how patients are tracking on their care plan and schedule, how they are feeling, and the financial status of the episode of care. And it provides real-time answers. Carelink takes inputs from both patients and providers to facilitate timely communication between both parties throughout the episode.  

Better care can only be achieved by stronger management of patient episodes of care. Episodes of care connect all aspects of healthcare technology – from coding and claims to data and diagnosis. Defining an episode of care in a value-based payment world can identify the care that is given and the future health of the individual.

Throughout time, healthcare and technology will only continue to grow more connected. The Connected Health Conference not only confirmed, but celebrated, the great health-tech resources that are aiming to make healthcare safer, stronger and better. Whether it’s hardware or software, patients and providers alike should be ready to incorporate these helpful tools into their habits.

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.

Announcing a Brand New Redesign for Carelink

We are proud to announce that Carelink has gotten a brand new redesign. Our web development team has been working hard to improve Carelink's user interface to make it even easier for bundled payment episode initiators and other providers to track their patients throughout an episode of care. Here are some highlights of the new design:

  • Episode List The Episode List is the master list of all the patients you are tracking. Use the filters at the top of the page to focus on all admitted patients, patients that need to be admitted, patients that need to be discharged, or patients that need a status update. You can see the bundle, care plan, last status update, and any red flags for each patient on this page.

  • Dashboard The Dashboard is where you can see your bundled payment program overview at a glance. New visualizations present the information in an eye-catching way and patient details help you immediately identify which patients need urgent attention.

  • Patient Details The Patient Details page has been reorganized to help you focus quickly on key information. The care plan is now represented by a timeline chart and the latest status updates will appear at the top of the patient's episode history.

  • Reports Use reports to monitor preferred provider performance, track SNF LOS trends, access a financial summary, and more.

If you are a Carelink user, log in to www.archwaycarelink.com and click "Try new design" in the header to see for yourself! We would love to hear what you think of it. Please let us know if you have any comments or questions.

Contact us for a demo here.

Webinar Recap: EPM Financial + Clinical Deep Dive

On Monday, February 20th, Archway Health presented a webinar with MedAxiom titled “EPM Financial + Clinical Deep Dive.” Ginger Biesbrock, Vice President, MedAxiom Consulting and Dave Terry, Founder & CEO, Archway Health were the featured speakers. Ginger introduced the topic and acknowledged that managing an episode of care can be complex. In order to do it successfully, providers must "simultaneously redesign and optimize care to drive quality and minimize cost, engage ALL providers who touch a patient across an episode of care, understand the entire continuum of care that is required to provide an episode, and track performance both clinically and financially across the episode—in all areas of care provision—as a whole but also by segments and individual providers."

Dave talked about the EPM program management process, upfront EPM analytics and opportunity assessment, and ongoing performance management dashboards.


"The goal of the upfront analytics and assessment process is to identify the main 2 or 3 operational focus areas that can drive improvement in the first few quarters," he said. At Archway Health, we encourage providers to choose just 2 or 3 priorities to focus on to start out, rather than trying to change everything right out of the gates. Areas of focus might include preferred post-acute network development, clinical process redesign, specialist engagement, discharge planning process redesign, physician gainsharing, and patient reported outcome tracking.


You can find more resources on the MedAxiom EPM Resource page. You can also contact Archway Health for more information by emailing info@archwayha.com.