The 4 Keys That Ensure Success of Physician Groups in Bundled Payment Programs

Bundled payments are proving to be quite effective in Medicare's attempt to shift from traditional fee-for-service to value-based payment models. BPCI bundled payments have been observed to save money while enhancing patient care. The newly unveiled BPCI Advanced program will begin in October and it aims to build on the success of the existing BPCI initiative. While there may be those who disagree, organizations that have been able to effectively implement bundled payments programs have found that such value-based care has created meaningful changes in the way healthcare is organized.

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The cost-effectiveness of the program and the care value it provides depends on how many physicians are willing to adjust the way they practice. One of the major costs that can be avoided is the extensive and often needless extended hospitalization stay during an episode of care. An ‘episode’ of care is the period of an acute illness or a surgical procedure and the following recovery period. If patients can be guided by their physicians to spend more time recovering at home, and be remotely monitored to make sure they are on track for recovery, this can drastically reduce the costs involved in their health care.

Under the existing BPCI program which ends on September 30, 2018, many physician groups have found themselves to be quite successful in their endeavors. Their experience offers valuable insights for other physicians to redesign their care practices. There are certain strategic elements that are the keys to ensure physician groups succeed in bundled payment programs.

1. Physician Engagement:

Making notable improvements in the healthcare systems with initiatives like the BPCI bundled payment cannot be achieved without proper physician engagement.

As the US healthcare industry reinvents itself with BPCI Medicare programs to improve outcomes of not just one patient, but that of the entire population, this renewal requires physicians to evolve, take charge and lead the rest. From delivering the frontline care to commanding leadership positions, physicians have a large role to play. Since they drive a crucial 75 - 85% of all quality and cost decisions, physician disengagement can translate into significant financial losses. Since a physician ’s training and outlook is different from that of the hospital managers, challenges are higher when it comes to coordinating their responses to the rapidly changing marketplace and regulations.

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The American Hospital Association defines physician engagement as: "Pronounced enthusiasm characterized by belonging, pride and loyalty which foster a mutually committed relationship between physicians and organizations resulting in the enduring pursuit of organizational goals and career enrichment."

The lack of physician engagement can eventually lead to burnout or the doctors leaving their jobs. Malpractice litigation is often a result of patient dissatisfaction arising from patient provider communication issues. Engaged physicians are usually able to communicate better with patients. They can motivate not only the patient but also the entire care team to coordinate across the episode and effectively implement the value-based care plan.

Following a surgical discharge, engaged surgeons are more likely to organize post-acute care when they are involved in a 90-day period care plan. This has a noteworthy impact on the patient’s utilization of such services and can positively impact patient care continuum.

2. Care Coordination Among Providers

A value-based healthcare system has a very complex mechanism that involves patients, hospitals, physicians, pharmacies, post-acute care and so on. 

In such a fragmented health care system, care coordination among its various players is one of the major keys to creating an effective bundled payment program. Physician engagement depends on the degree to which doctors feel committed to the hospital’s mission and values. Post-acute care providers must be willing to follow the physician’s care plans and outcome goals.

Case managers must coordinate the care of post-acute care providers and surgeons to streamline the care protocols. It is most important for all involved to keep the lines of communication open. Training programs that focus on improving patient-provider communication skills can lead to remarkable progress inpatient treatment adherence as well as patient satisfaction.

Care Coordination is very difficult as there are many moving parts for providers inside and outside the network, various providers along the patient's recovery path, and an immense amount of detail to manage -- and much of the coordination is now performed - the old fashioned way -- post-its and phone calls (or no coordination at all).

3. Patient Optimization

Addressing manageable conditions before resorting to surgeries helps avoid unnecessary costs and health complications. Postoperative care not only involves medical assistance from care providers but also the self-management of mental, physical and environmental conditions that can adversely affect the outcomes after surgery.

An increased focus on patient optimization is required for the successful implementation bundled payments for care improvement. Chronic medical conditions like diabetes, hypertension, asthma, etc can negatively impact surgical outcomes if not managed appropriately. So rather than just focusing on the surgery alone, an overall health care plan has to create.

Surgeons must direct the patient to the resources that can help them manage behavioral health issues such as alcoholism, smoking, depression or anxiety. It is helpful to have a licensed clinical social worker on the health care team to provide such advice and ensure patient care continuum.

It is important to involve the circle of caregivers in monitoring and supporting patients during their recovery. Telehealth software or patient management platform from Lifecycle Health is great for arranging quick and effective patient video visits.

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4. Data Analytics

Another key element of successful bundled payment programs is Data analytics. The rules and regulations surrounding bundled payment initiatives like the BPCI Advanced can leave most confused. Many care providers refuse to get involved as they don’t really understand the complexities or they may feel the risks are too high.

The best way to address this resistance is the effective use of data analytics. Comparison of the data on individual physician performance can encourage healthy competition among physicians which will eventually lead to better value-based care and treatment outcomes.

Data analytics help pinpoint variations in care plans as well as the protocols that need to be updated. Such analytics can help organizations redesign their strategies to tailor unique and detailed care plans that are more effective in providing value-based care at lowered costs.

The Lifecycle Health cloud platform engages and monitors patients as well as their circle of caregivers to collect and analyze data. With its state of the art Telehealth software, Lifecycle Health provides real-time visibility into the care quality, patient satisfaction and costs across providers to ensure your organization’s success in bundled payment programs.     

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