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.

Archway Examines the Impact of Bundled Payments Ahead of Expected New CMS Programs

WATERTOWN, Mass.--(BUSINESS WIRE)--According to a survey conducted by Archway Health – a Boston-based firm specializing in managing bundled payments programs – participation in bundled payments has improved the quality of care, and anticipation and preparation for new programs remains high. The survey assessed the perceptions and efficacy of bundled payments ahead of the expected announcement of a new bundled payments program from the Centers for Medicare and Medicaid Services (CMS).

The survey results are based on responses from 70 participants across the U.S. The participants, which included executives, administrators and clinicians, represented the continuum of healthcare from hospitals, specialty care, post-acute facilities and home health care.

Key findings from Archway’s survey indicate the impact of bundled payments:

  • 75% of respondents say involvement in these programs has improved quality of care, whether it lowered costs or not.
  • 63% of respondents say bundled payments has both improved quality and lowered cost.
  • The most prominent reason for not participating in bundled payments was the potential administrative burden. No respondents cited a limited return on investment as a reason for not participating.

“It was great to get such a strong and positive response that confirms what we’re seeing with our provider partners – bundled payments work,” said Dave Terry, founder and CEO of Archway Health. “Bundled payments will continue to play a major role in healthcare as we move from volume to value, especially as we move toward models that encourage efficiency and improvements in care quality. Archway is dedicated to helping specialists succeed in all of these programs as they continue to grow.”

Other findings from the survey indicate healthcare professionals’ attitudes towards bundled payments:

  • As CMS is expected to release a second generation of Bundled Payments for Care Improvement (BPCI), 75% of respondents are “definitely” or “probably” planning to participate.
  • When it comes to bundled payments, 25% of healthcare professionals say they are “100% ready” to implement them, while 56% are “getting prepared” or “just started the process” with more to do.

“It’s great to see that healthcare professionals want to participate in bundled payments and are actively preparing to do so,” said Keely Macmillan, general manager of BPCI for Archway Health. “Bundled payments offer clinicians and healthcare professionals the opportunity to take control of the entire care process and ensure patients achieve the best outcomes in a cost-efficient manner.”

Since its inception in 2014, Archway Health has been active and solely focused on bundled payments. Specialists and providers partner with Archway to receive guidance on how to navigate every step of bundled payments participation.

To learn more about bundled payments, the survey, the anticipated new CMS program and how it impacts providers, please contact

About Archway Health

Archway Health, founded in 2014 and built on a deep foundation of healthcare payment reform expertise, works with providers to design and execute care and risk management initiatives that drive success in bundled payment programs. Archway is currently working with leading healthcare providers participating in the CMS BPCI and OCM programs, as well as with commercial payers operating bundled payment initiatives. To support these programs, Archway works with providers to analyze their opportunities and risks and to deploy its comprehensive platform of analytics, patient tracking tools, and advisory services to ensure their success in bundled payments. For more information, please visit


For Archway Health Olivia Armstrong, 781-924-6714

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

Dave Terry Featured in Videos from Cancer Center Business Summit

Archway Health is featured in video interviews from the Cancer Center Business Summit that are now live on OBR’s video center. In these short videos, Archway Health Co-Founder and CEO Dave Terry answers questions about Alternative Payment Models. Check out the videos below. What are the keys to success when participating in Alternative Payment Models?


What are the Alternative Payment Models of the future?


Why should practices participate in Alternative Payment Models?


You can watch all the videos and related videos here:

Archway Health to Present EPM Webinar with MedAxiom on February 20th

EPM Financial + Clinical Deep Dive

Monday, February 20, 2017 1:00 p.m. - 2:00 p.m. EST


Archway Health will present a webinar with MedAxiom titled "EPM Financial + Clinical Deep Dive." Ginger Biesbrock, Vice President, MedAxiom Consulting and Dave Terry, Founder & CEO, Archway Health are the featured speakers.

From MedAxiom:

EPM webinar number #3 will walk you through an analysis of sample CMS data to look at costs of episodes and the breakdown, showing benchmarking and areas of opportunity. The second half will provide insights on how to look at your clinical programming to better understand opportunities related to throughput, transitions, alignment and care coordination.