ACO roundup: Early findings on CMS bundled payments remain 'limited'

Key accountable care news from Feb. 26 to Mar. 4

CMS releases inconclusive bundled payment report. CMS Innovation Center's first annual evaluation of Medicare's bundled payment initiative offers few conclusive findings, reports Modern Healthcare's Paul Demko. The report—which was prepared by the Lewin Group—states, "We are limited in our ability to draw conclusions about the effects of (the Bundled Payments for Care Improvement program) because of the small sample sizes and short time-frames," adding, "As a result this first Annual Report may be better thought of as the outline for future analyses as more participants enter BPCI and gain greater experiences under the initiative."

Get a breakdown of the four BPCI bundling models

Hospitals have room for improvement in caring for vulnerable populations, surgeon argues. Cardiac surgeon David Theodoro, who practiced at the Mayo Clinic for three years, says many providers talk about population health in a "conceptual way," but have difficulty understanding the true impact of new types of care management on individual segments of patients—namely the top 5% of patients responsible for 45% to 50% of health care spending. "These 5% of patients are the most critically ill and represent the largest cohort of patients with care variability and care gaps compared to the other cohorts," says Theodoro. In order to ensure a hospital is best using its various resources, physicians should develop better ways to segment patients and determine clinical deterioration as early as possible, he argues. Theodoro concludes, "Think about a Venn Diagram where one circle is the ICU, one is the ED and one is the OR. Where those circles cross, that's where the 5% of patients have the most resource utilization," adding, "In those areas, further characterization on a moment-by-moment basis of clinical overall status has a lot of room for improvement."

An invite to join CMS's new learning network. CMS's Patrick Conway, Karen DeSalvo, and Meena Seshamani recently invited employers, providers, patients, and other health care stakeholders to join CMS's Health Care Payment Learning and Action Network. The three officials discussed the network at the Advisory Board's Future of Health Care 2015 summit last month.

Results from the first year of value-based modifiers. CMS last month released results from the first year of the value-based payment modifier for physicians. Based on performance in 2013, nearly 7,000 physicians at 14 practices will receive an increase in 2015 Medicare payments.

From the Advisory Board:

Expand your service line metrics to see value-based care success. When providers participate in risk-based payment models, they must tackle a host of new strategic questions to be successful and grow. Regardless of a provider's participation in risk-based payment, their patients, referring physicians, and purchasers now use value-based criteria to choose providers.

How to make your population health strategy actually work. CI networks. Medical groups. ACOs. As health systems invest in new assets to manage population health, they're also struggling to make these pieces work together. Our solution? Think like an MSO.


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