Industry Insights

Data Is Key to Navigating Collaboration Efforts in Advanced Payment Models

December 2016
Author:  Raymond Belles

Raymond Belles

Managing Consultant

Consulting

910 E. St. Louis Street, Suite 200
P.O. Box 1190
Springfield, MO 65801-1190 (65806)

Springfield
417.865.8701

For post-acute providers to succeed in the evolving landscape of advanced payment models (APM), they need to harness data showcasing their value to potential health care collaborators. The Centers for Medicare & Medicaid Services implemented the mandatory Comprehensive Care for Joint Replacement (CJR) Model for 67 metropolitan statistical areas (MSA) on April 1, 2016, and has a proposed rule for a Cardiac Rehabilitation (CR) Incentive Payment Model for 98 MSAs, potentially to begin mid-year 2017. Both of these payment models present risk across the continuum of care shifting from volume- to value-based care.

In both the CJR and CR models, hospitals will be financially accountable for an anchor hospitalization and 90-day episodes of post-acute care. Post-acute providers, including skilled nursing facilities, inpatient rehabilitation facilities, home health agencies, etc., will need reliable and timely data to demonstrate the value they provide in achieving quality outcomes and lowering cost of care. Providers equipped with this information are more likely to be welcomed as a collaborator by hospital systems. As hospitals must manage 90-day episodes of care according to market target prices, they’re going to pay close attention to what effect post-acute care providers have on reconciliation payments set to begin in 2018.

Based on the wide Medicare payment variances to post-acute care providers, home care organizations are well positioned to be key collaborators within hospitals and in some cases, as allowed by APMs, selected as a preferred provider. Post-acute providers that measure and monitor data to manage organizational accountability have an opportunity to be a step ahead in their competitive market. Providers being proactive rather than reactive have a greater chance of achieving higher-quality outcomes and lowering cost of care.

In addition to managing quality outcomes and the patient experience, home care providers need to equally focus on new key performance metrics demonstrating effective cost management, including:

  • Average payment per CJR or other defined condition’s episode of care
  • Average payment per episode of care based on first discharge location
  • Readmission percentage for CJR or other defined condition’s episode of care
  • Average market readmission rate for CJR or other defined condition’s episode of care

As the health care landscape continues to change, home care providers will be expected to adjust how they participate in the care continuum but also depend on data for crucial decisions. Historically, home care providers haven’t had the kind of data readily available that will be required to manage an APM environment. However, the data is now available to participating hospitals and also can be available to home care and other post-acute care providers.

BKD’s dedicated team of APM specialists understand the challenges post-acute providers face in the changing landscape and the need to harness data. BKD is prepared to assist you in developing a strategy using BKD’s Big Data & Analytics. Visit our Payment Reform Resource Center to learn more about our Outcomes Compass for Home Care or contact your BKD advisor for more information on navigating APMs.

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