Archway News

Advice for Bundled Payments: Dave Terry on The Shifting Risk Landscape

Advice for Bundled Payments: Dave Terry on The Shifting Risk Landscape

For the inaugural edition of our “Advice for Bundled Payments” blog series, we sat down with our CEO and Co-founder, Dave Terry. Dave has spent more than 20 years in healthcare, developing skills and a passion for helping change the way physician groups and health systems manage care and risk through payment reform. We asked Dave about his thoughts on the healthcare industry as a whole and how bundled payments fit into its future.

Providers Flock to BPCI Advanced for More Than Just the Savings

BPCI Advanced has been a hit with providers, which has CMS expressing enthusiasm for the level of interest in the new program.

In a recent Archway Health webinar, we polled 80 providers to capture why they applied to BPCI Advanced and what they hope to gain from the program.

Opportunity for New Revenue

Not surprisingly, the primary reason many providers have applied to participate in BPCI Advanced is to seize the opportunity to generate more revenue for their organization. More than three-quarters of respondents, 77%, said they applied because of the “opportunity for new revenue.”  

The new applicants have likely seen and heard about the revenue generated by their peers who participated in the original BPCI program. Archway’s partners in BPCI earned on average $3,000 per episode of care. And now with best practices and a second-generation of the program, providers in BPCI Advanced will be able to achieve even better results.  

Automatic Bonus

The opportunity for providers to generate revenue with BPCI Advanced is twofold. In addition to the rewards for efficient and effective care, BPCI Advanced participants that meet certain requirements will automatically qualify for a bonus that is awarded to those in the Advanced Alternative Payment Model (APM) track under MACRA. Nearly half of survey respondents, 45%, said they applied to BPCI Advanced “to qualify for the 5% APM bonus under MACRA.” 

Stepping Stone to Commercial

More than half, 52%, of respondents said they applied to BPCI Advanced to prepare for commercial bundles. Commercial bundles are self-designed and self-guided programs, thus requiring a certain level of bundled payment expertise to achieve success.

At a recent conference, our chief analytics officer, Dr. Mah-J Soobader told audience members, “The pathway to commercial is experimenting in Medicare programs, and experimenting successfully.” Astute, future-minded providers who are planning to contract directly with commercial health insurance plans down the road are experimenting now with BPCI Advanced to gain the experience to manage their own bundle programs.

Vehicle for Change

Providers increasingly recognize the need to move from volume to value, but it is difficult to implement change without incentives, tools, data, or structure.  BPCI Advanced presents a framework for providers to ease into value-based case by providing:

  • Upside reward with downside risk protection
  • The opportunity to start small with just one bundle
  • Data to analyze in advance
  • The opportunity to drop out of the program at certain stages    

Just putting in an application can give providers insight into specific aspects of care and operations that have room for improvement and can spark a conversation between leaders about the best ways to go about it. 40% of respondents recognized this benefit of bundled payment programs and said they applied to the BPCI Advanced “to use the program as a vehicle for organizational change.”  

New Features More Attractive

BPCI Advanced builds on the original BPCI program with new features informed by data and provider feedback. One of those new features is an updated pricing methodology that has been adjusted to be more equitable and attractive to both low- and high-cost providers.

In our survey, 30% of respondents answered: “the refined pricing model might offer more incentive to their organization than that of the original BPCI program.” As providers prepare to receive their data and target prices in the coming months, it is important to keep in mind that success will be driven not just by your initial pricing, but also by your opportunity to increase savings relative to your peers over time.

Additional survey results revealed:

  • 67% of respondents that applied to BPCI Advanced had not participated in the original program
  • 39% of respondents have experience in risk-based contracts
  • When looking at a convener for partnership in BPCI Advanced, providers’ priority needs include analytics, bundled payment expertise, risk protection, and guidance in redesign among other things.

As Archway predicted when CMS first gave indication of BPCI Advanced, the program has attracted many providers new to bundled payments. We are excited by the response and committed to helping providers succeed.

For those who missed out this time, there will be another chance to apply in 2019.

Contact our team to learn more.

BPCI Scorecard Provides Snapshot of Potential Savings

REQUEST YOUR BUNDLED PAYMENT SCORECARD HERE: While the release date is still undetermined, the Centers for Medicare & Medicaid Services (CMS) is expected to unveil the next generation of its existing Bundled Payments Care Improvement (BPCI). The continuation of this vital healthcare initiative will herald a new era for efficiency in care management.

While it remains to be seen what the next model will be called—Advanced BPCI, BPCI Advanced, or something different—we do know it is coming. And it’s clear that providers are best served by getting ready. Until CMS announces the official name, we’re calling it BPCI Advanced.  

This next generation in the bundled payments movement will be an important opportunity for specialists and specialty providers in particular. It is the first new Medicare bundled payment opportunity for specialists since early 2014. For those already enrolled in BPCI, this is a moment to enhance the efficiencies their practices have already achieved. For those new to bundled payments, this is an ideal time to step toward the future of value-based healthcare.

At Archway Health, we are here to guide your organization, whether you’re a single specialist or a large specialty provider, in the process of preparing for and adopting BPCI Advanced. Let us help you answer what is most likely your first question: Will it be worth it for our practice to join BPCI Advanced program?

In anticipation of BPCI Advanced, we have developed the “Bundled Payment Scorecard” to offer a comprehensive look at the potential savings and efficiencies for your practice. We focus on the factors that have the most dramatic effect on the improvement of payment processes and patient outcomes:

  • Total Episodes
  • Total Medicare Spend
  • Total Post Acute Spend
  • Skilled Nursing Facility Utilization
  • Average Skilled Nursing Facility Length of Stay
  • Readmission Rate

Through these metrics, we provide a snapshot of your practice’s revenue opportunity with adoption of bundled payments. Specialists using our platform have saved on average more than $2,000 per case, and have provided an improved standard of care to their patients.

BPCI Advanced Scorecard

We understand that doctors and practice managers may be confused as to the future of bundled payments, and have little time to do extensive research on the subject. In a free, 30-minute consultation, we can walk you through both an overview of the evolving landscape of BPCI and share your custom Bundled Payment Scorecard.

We’re excited for the announcement of BPCI Advanced. Since our founding, we have focused only on bundled payments—it’s all we do. And we believe in the importance and potential of this space so much that our model is to share both the downside risks and upside rewards with our partners. In other words, we only get paid when you succeed.

The window for applications to enroll for the BPCI Advanced program is expected to open with the CMS announcement. Interest is already very high. If you’re looking to learn about this opportunity for your organization, we invite you to please contact our team at today.

It takes very little time, and we promise that time will be very well spent.

Upcoming Conferences: CV Transforum and AAOE

Archway Health will be presenting and exhibiting at two upcoming conferences in April. CV Transforum

CV Transforum will take place Tuesday, April 18th through Thursday, April 20th at the Ritz-Carlton, Amelia Island, Florida.

Ed Bassin, PhD, Archway Health Chief Analytics Officer, and Dave Terry, Archway Health Founder and CEO, will speak at a CV Transforum pre-conference session titled "EPM (Bundled Payments) Boot Camp." Also speaking at the session are Anne Beekman, RN, Vice President, MedAxiom Consulting; Ginger Biesbrock, PA-C, MPH, MPAS, AACC, Vice President, MedAxiom Consulting; Tim Kennedy, Shareholder, Hall, Render, Killian, Heath & Lyman, P.C; and Joel Sauer, Vice President, MedAxiom Consulting.

From the CV Transforum agenda:

On December 20, 2016, CMS published the final rule, Advancing Care through Episode Payment Models and Cardiac Rehabilitation Incentive Model. CMS’ stated goals of this rule is to improve quality of care in the applicable episodes, while reducing episode spending through financial accountability.

This intensive, small group boot camp session will allow for depth of discussion and very detailed information sharing on everything you need to know about the final rule. We will provide expert clinical, financial and legal education so you can learn how to benefit from it whether in a chosen MSA or not. This essential boot camp will hit all of the important components of this new rule and the implications to AMI and CABG episodes. Our expert policy, legal and consulting panel will bring valuable insights around the complexities of the rule and discuss how to leverage it while improving the quality of care you provide.

Topics to be covered include:

  • Final Rule Summary
  • Review of the MedAxiom EPM Data
  • Clinical Needs Inside Bundles (pathways, standardization)
  • Infrastructure & Alignment Requirements (governance, leadership, physician comp)
  • Importance of Coding & Documentation
  • Legal Update (acceptable gain sharing arrangements)
  • Q&A

Whether you are in a chosen MSA or not, and regardless of what the new administration does, EPMs and value-based medicine is the inevitable future of health care. Stay ahead of the curve and be prepared for the future by participating in this essential bundled payment educational event.

Learn more about the Spring '17 CV Transforum and register here:


AAOE Annual Conference

Archway Health will also be at the AAOE (American Alliance of Orthopedic Executives) Annual Conference, which takes place at the JW Marriott Hotel, Indianapolis, Indiana from Saturday, April 22nd to Tuesday, April 25th.

From the conference website:

The AAOE Annual Conference brings together more than 500 orthopaedic practice executives and their staff from around the country for four days of education, networking, and professional development. The conference allows practice professionals to stay up-to-date on the latest industry trends while networking and learning alongside peers.

Learn more about the AAOE Annual Conference and register here:

Got a question about bundled payments? Ask us now.

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 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.