Industry Insights

Claims Data’s Power for Decision Making

June 2017

You’ve likely read articles encouraging organizations to use data to guide them through the changes involved with bundled payments. If you’re fortunate, you have a data analytics team providing valuable insights. However, converting claims data from the Centers for Medicare & Medicaid Services into actionable information for various transformation teams isn’t easy. Analyzing millions of lines of data can tax analytics teams; supplying specific insights to transformation teams creates dozens of necessary reports.

However daunting this may seem, it’s important for bundled payment model success. These are critical resources for bundled payment success:

  • It’s important to access claims data. Bundled payments are partially based on your region’s performance, so it’s best to analyze your data and benchmark against peers.
  • Assemble your care transformation team with clinical, financial and operational leaders who will be the primary change drivers.
  • Compile a data insight list for each team’s needs, frequency of updates and instructions on how to source and calculate metrics. When considering complex standardization calculations and exclusions, this step often presents an unexpected hurdle:
    • Outline achievable goals, timelines and accountability metrics. The goal in a bundle is constant improvement as the target price moves semiannually. Establishing clear goals and key metric monitoring is paramount. In BKD’s experience, organizations need to select metrics that provide a comprehensive view of organizational performance in bundled payments, including clinical, presurgery, surgery, post-surgery and post-acute. 
  • Consider the patient experience across the continuum of care instead of clinical, financial and operational silos. In the Healthcare Financial Management Association Transformation Innovation report, the association recommends using technology to improve the patient experience even after they leave their building.
  • It’s paramount to intentionally select high-value collaborators—regardless of whether you gain share with them—and communicate clear expectations.

A benefit of navigating bundled payments with a trusted advisor is accessing program-specific best practices that produce measurable results—both clinically and financially.

Based on our experience with Bundled Payments for Care Improvement, Comprehensive Care for Joint Replacement and the Episode Payment Model, we’ve compiled a list of metrics important to monitor during each phase of the patient experience and a host of resources. If you feel empowered to start tackling bundled payments or incorporate best practices into your efforts, download the Beginning Bundles Guide.

Contact your BKD advisor if you have questions.

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