transition to value-based care - bpci advanced overview ... · health payer intelligence, ......

2017 Remedy Partners, LLC. All Rights Reserved.©.

2017 Remedy Partners, LLC. All Rights Reserved.

Transition to Value-Based Care - BPCI Advanced Overview

Gene Huang & Mary Moscato

November 30th


1. Who We Are

1. Our Mission

2. Remedy Partners Overview

2. The Transition to Value-Based Care (VBC)

1. Value-Based Care Landscape

2. Bundled Payments Overview – Model 2 and 3

3. Pricing - What is the financial incentive?

4. Strategy- What is the business development incentive?

3. Remedy’s Model 3 Program

1. Our Role and Services

2. Program to Date

4. Next Steps

1. BPCI Advanced Timeline

2. Getting Started

Agenda

2

2017 Remedy Partners, LLC. All Rights Reserved.©.| |

Remedy Partners delivers technology and

services that enable payers and providers to

organize and finance a patient’s episode of care.

3


Remedy Partners is the largest Awardee Convener in the BPCI program.

Remedy Partners at a Glance

Sources: Volume and program size data as of July 2017 reconciliation, 2013Q4-2016Q4,

all Model 2 and Model 3 episodes, with retro drops removed. Demographic data as of

July 2017 reconciliation, 2016Q1-2016Q4, all Model 2 and Model 3 data.

5,400Unique physicians

initiating episodes

1,300Post-acute sites at

which physician

groups initiate

episodes

730Hospitals at which physician groups initiate episodes

410Skilled nursing

facilities initiating episodes

110Physician groups

initiating episodes

340,000Cumulative BPCI episodes managed to-date

$8.4BCumulative medical spend managed to-date

45States in which we manage episodes

1,000Unique EHR Integrations

18MMonthly EHR Transactions

Who We Are

4


Some AJAS members already working with Remedy and with BPCI

Remedy Partners at a Glance – AJAS Overlay

2AJAS Members in

Model 3 with

Remedy Partners

2AJAS Members in

Model 3 separately

5+Members already

evaluating BPCI Advanced

6+Facilities working

with Remedy Model 2 partners

Who We Are

5

• Red = AJAS Members

• Blue = Remedy Model 3


Value-Based Care

Landscape

6


CMS is Dedicated to Innovation Commercial Payers are Following

Payment Reform is Here to Stay

Leading providers and payers have been increasingly shifting away from fee-

for-service structures and embracing the transition to value-based care through

the adoption of Alternative Payment Models (APMs).

On September 20th, the Centers for Medicare

and Medicaid Services (CMS) published a

Request for Information

MA membership moving to VBC

Payments tied to membership in VBC models:

Source: Humana press release, http://press.humana.com/press-release/current-releases/fullwell-enters-new-value-based-agreement-humana-colorado

Advisory Board, https://www.advisory.com/daily-briefing/2015/01/29/20-health-systems-insurers-agree

Health Payer Intelligence, https://healthpayerintelligence.com/news/unitedhealthcare-cut-costs-through-value-based-care-programs

2018

2018

2020

75%

75%

Current spend tied to VBC models

$65B

“Strengthening Medicare and Medicaid will

require health-care providers to compete for

patients in a free and dynamic market, creating

incentives to increase quality and reduce costs”

CMS’ announcement promotes:

Consumer empowerment and transparency

Increased and continuous competition

Use of waivers to enable meaningful innovation

The Transition to Value-Based Care

7



Bundled payments significantly

improve care and cost

outcomes and can be integrated

into other VBC models to drive

greater overall efficiencies.

Bundled Payments Drive Success

in Concert with Other VBC Models

Home Health Value-Based

Program

Skilled NursingFacility

Value-Based Program

Comprehensive Care for Joint Replacement

(CJR)

Value Modifier

Bundled Payment for Care

Improvement (BPCI) Initiative

Next Generation

ACO

Merit-Based Incentive Payment System

ComprehensiveESRD Care

Medicare Shared Savings Program

Comprehensive Primary

Care Plus(CPC+)

Hospital Readmissions

Reduction Program

Oncology Care Model

Million Hearts Cardiovascular Disease Risk

Reduction Model

Independence at Home

Demonstration

IMPROVED PATIENT

CARE AND COST

OUTCOMES

8


Current BPCI Program

• Four BPCI models offered through the initiative, with more than 75% of participants selecting Model 2 or 3

➢ Model 2 episodes are initiated by an inpatient admission to an acute care hospital and include related care

covered under Part A and Part B within 30, 60 or 90 days following discharge from hospital

➢ Model 3 episodes include post-acute care following an inpatient acute care hospital stay and all related care

covered under Medicare Part A and Part B within 30, 60 or 90 days following initiation of post-acute services

• Targeted 181 MS-DRGs rolled into 48 Bundles (24 surgical and 24 medical conditions)

• CMS Awardee Conveners lower the barrier to entry for provider participation by bearing financial risk and

operationalizing program administration


Continued voluntary

participation

• Bipartisan support for voluntary bundles

• CMS recently scaled back mandatory

CJR and Cardiac programs

Advanced APM status

under MACRA

• BPCI Providers eligible for 5% MACRA

bonus

• Dependent upon certain percentage of

Medicare Patients going through an APM

• New advanced APM designation for BPCI

Quality-based

performance measures

• Complications and mortality statistics

• Patient satisfaction scores

• Patient reported outcome metrics

(where applicable)

Anticipated Enhancements to BPCI Advanced

The Evolution of Bundled Payment Programs Launched in 2013, the BPCI program is the largest demonstration program in

CMS’s history covering $8 - 10B in Medicare fee-for-service payments.

9


Skilled Nursing Challenges

Remedy Partners understands that Skilled Nursing Facilities (SNFs) are

facing a complex market where patient volume and margins are decreasing.

10

• Referral streams are decreasing as partners become more selective in which

SNFs to send their patients after discharge.

• SNFs face greater competition for referrals from Home Health Agencies (HHAs)

as hospitals push patients to lower cost settings.

Narrowing referral networks

• Downward trend in SNF reimbursement rates combined with lower patient census

have eroded SNF margins.

Declining margins

• Providers are facing pressure from hospital partners to shorten LOS as much as

possible to reduce episode costs while maintaining quality.

Downward trend in Length of Stay (LOS)


Increasing Growth and Performance with BPCI

BPCI allows SNFs to gain a competitive advantage in their markets.

11

Provides an opportunity to increase margins and revenue • SNFs can take control of the

bundle and assume risk in

Model 3, reaping the financial

rewards for effectively

managing patients across the

episode.

Allows SNFs to gain access to valuable CMS data without cost• SNFs gain access to their

historical data in the

Opportunity Analysis phase of

BPCI.

• Remedy Partners analyzes this

information at no cost to

determine the financial upside

for partners.

Positions SNFs for long term success in the post-acute care market • CMS is committed to rewarding

providers that accelerate value

based care. Model 3 SNFs gain

a competitive advantage for

increasing hospital referrals,

Medicare business and census

development.


Remedy’s Model 3 Program

12


Our Model 3 Expertise

Our expert team utilizes its national expertise and commitment to the SNF

market to support provider operations.

11

• Remedy Partners is the largest Awardee Convener in the Model 3

program, supporting 400 SNFs.

• Our scale allows us to finance, structure and deploy bundle

payment programs for facilities of varying sizes and geographies

with no impact on cash flow.

Largest Model 3 Awardee Convener

• Our Model 3 project managers utilize data insights to craft

specialized programs to improve provider performance based on

demand.

• These programs focus on driving improved care, lowering costs

and improving patient satisfaction.

Specialized Program Development

• Our account management team focuses on driving operational

success with our SNF partners.

• AMs hold monthly business reviews and provide best practices for

managing BPCI operations and meaningful data insights that

promote clinical, operational and financial success.

Dedicated Account Management (AM) Team


Remedy Model 3 Outcomes

With our solution, providers have been able to improve quality of care while

driving down costs.

14

1CMS 2016Q4 Reconciliation results for Q22015-Q42016; due to low volume includes only SNF systems with 3 or more SNFs live in 2018Q1; savings rate calculated as net

payment reconciliation amount as a percentage of target spend, not including CMS 3% discount; Includes all true-up results; some quarters not fully reconciled2CMS Monthly claims, compares 2009-2012 baseline period to 2016 live bundles

Range of Program Saving Rates

by Remedy SNF System1

16.6%Reduction in

90-day episodes with a

readmission2

-10%

-5%

0%

5%

10%

15%

20%

25%

30%


Remedy Model 3 Outcomes

We work closely with partners to maintain high program and bundle retention

in order to achieve positive financial returns.

15

1CMS 2016Q4 Reconciliation results for Q22015-Q42016; positive financial results defined as combined positive net payment reconciliation amount (NPRA) Q22015-Q42016.

Includes all true-up results; some quarters not fully reconciled; due to low volume, includes only SNF systems with three or more SNFs live in 2018Q1.2Comparison of BPID and Bundle selection counts between CMS Q42015 Analytic File and CMS Q22017 Analytic File; includes all Model 3 provider types

92%Remedy SNF systems with

positive financial results1

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Providers Retained Bundles Retained

Remedy Participants Non-Remedy Participants

BPCI Program Retention (2015Q4-2017Q2)2


Hebrew SeniorLife –

Experiences of a Remedy

Client

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Hebrew SeniorLife

• The largest provider of senior care in the Boston metropolitan area

• A non-profit, non-sectarian, integrated, eight-site system of health care, housing, research and teaching

• Devoted to innovative gerontology and geriatric research, senior health care, long-term nursing home care, and Greater Boston senior housing communities that improve the lives of older adults

• Serves people of all faiths and backgrounds

• An affiliate of Harvard Medical School

Housing/ Independent Living

Assisted Living

Skilled Nursing

Long Term Acute Care

Long Term Care

Outpatient Medicine

Outpatient Rehab

Day Health

Home Health

OP Hospice

Research

2017 Remedy Partners, LLC. All Rights Reserved.©.||

Satter House

Hebrew Rehabilitation

Center

Center Communities of Brookline (3)

Fireman CommunityOrchard Cove

NewBridge on the Charles


HSL Did Apply –

• Contracted with outside Convener to assist with data tracking from

CMS claims.

• HSL’s IT /Fiscal departments teamed up for improved readiness of

tracking costs by patients and conditions

• HSL’s choice of bundles will demonstrate opportunity to reduce

Medicare expenses

• HSL can manage costs after SNF discharge due to ownership of

continuum (i.e., Home Care and Outpatient Therapy care)

• Added Care Transitions Coordinator


Selected Episodes of Care for July 1, 2015

Roslindale

• 15 selected (only favorable)

• In-service nursing, rehab,

physician, case management

and home care teams

• Created a color-coded

spreadsheet of ‘favorable

‘DRGs by location and

Episode LOS

• 4 additional DRGs added in

July for October 1, 2015 ‘go

live’

NBOC

• 18 selected (only favorable)

• In-service nursing, rehab,

physician, case management,

and home care teams

• Created a color-coded

spreadsheet of ‘favorable’

DRGs by location and

Episode LOS

• 5 additional DRGs added in

July for October 1, 2015 ‘go

live’


Morning Meeting and Board Management


Project Manager, Care Transitions and

Accountable Care


Remedy Model 3 Benchmark Savings

24

2017 Remedy Partners, LLC. All Rights Reserved.©.25

Top 3 Performing Bundles: 2016 Q4

BUNDLES EPISODES NPRA NPRA %

Complex non-cervical spinal fusion 2 $40,976 49%Major joint replacement of the lower extremity with

hip fracture split51 $36,852 5%

Sepsis 6 $33,166 19%

Top 3 Performing Bundles: Program To Date

BUNDLES EPISODES NPRA NPRA %

Major joint replacement of the lower

extremity222 $208,580 6%

Spinal fusion (non-cervical) 37 $176,592 22%

Major bowel procedure 15 $120,686 30%


Patient ID Accuracy

On average, each Remedy Model 3 patient identified in Episode Connect

generates $500 in additional savings (NPRA, not winsorized).

2016 Q4 RECONCILIATION | PATIENT ID 26

2017 Remedy Partners, LLC. All Rights Reserved.©.27

60 Day Bundles

2016 Q4 vs Adjusted Historic

82 Episodes

15.4% decrease in SNF Covered

Days

3.9% percentage point decrease in

Episodes

with a readmission


Next Steps

28


CMS Requires indication of interest

Remedy’s process starts with Non-Binding Letter of Intent (LOI)

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• LOI allows Remedy to include all of your facilities in our application to CMS

for BPCI Advanced

• LOI gives CMS permission to share your claims data and pricing for bundles

in your facility with Remedy for analysis on your behalf

• Non-binding agreement allows you to exit at any time, with no penalties, no

fees, no commitments

• LOI will be followed by Participant Agreement should you want to continue in

the program with Remedy


Success Starts with Selecting the Right Bundles

Our unrivaled expertise in bundle selection methodology for SNFs

guarantees providers are primed for success.

14

Before CMS delivers your data, we start with Medicare’s national dataset of all providers (LDS).

Preliminary Data Review

Early analysis identifies savings, mitigates risk and accounts for your unique strategic, operational and

clinical needs.

Program Opportunity Analysis

This provides an invaluable head start on implementing your program before receiving CMS

pricing data.

Operational Readiness Assessment

Remedy Partners will evaluate BPCI bundles against your historical performance to choose the ideal

bundles set for your organization.

Final Bundle Selection & Submission


Remedy Partner Implementation Workflow

Our comprehensive implementation approach ensures SNF providers are

ready to execute on their bundles.

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BPCI Program

Structure

Education and

Configuration

Care Redesign

Implementation

Program

Management

We finalize bundle

selection, program

goals and identify

BPCI champions so

your team is ready to

execute on your

bundles.

During this stage, we

educate your staff and

key stakeholders on

BPCI processes

through Remedy

University and

configure Episode

Connect.

Your team has direct

access to our Model 3

team who will finalize

your patient

identification program

and provide support for

your clinical,

operational, financial

efforts.

We work with your

team to implement care

redesign programs to

ensure optimal length

of stay and effective

discharge programs with

Next Site of Care (NSOC)

are established.


Gene Huang

VP of Business Development

[email protected]

Contact Information

32

Mcknight’s Article by Gene HuangThree Reasons Your SNF Should Sign Up for CMS’s BPCI Program

http://www.mcknights.com/guest-columns/three-reasons-your-snf-should-sign-up-for-cmss-bpci-advanced-program/article/704708/

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