A brand new report says that capturing participant experiences in each the Bundled Funds for Care Enchancment (BPCI) Superior Mannequin and ACO fashions might help inform how bundled funds is likely to be integrated into ACOs sooner or later.
In Mannequin Yr 4, the BPCI Superior Mannequin, which started in 2018 and is scheduled to conclude in 2025, resulted in Medicare program financial savings for the primary time because the mannequin started in 2018, in keeping with a Could 2024 report ready by the Lewin Group Inc. with companions Abt Associates,GDIT, and Telligen.
Financial savings have been achieved not just for surgical episodes however for medical episodes as effectively. The report explains that these financial savings resulted from important adjustments to the mannequin in Mannequin Yr 4, together with a shift from permitting contributors to pick out particular person scientific episodes to requiring them to decide on broader scientific episode service line teams (CESLGs). There have been additionally adjustments to the goal value methodology, together with a retrospective development adjustment. CMS made these adjustments after the BPCI Superior Mannequin resulted in internet losses to Medicare in Mannequin Years 1 by way of 3, which raised issues that focus on costs might have been set too excessive, significantly for medical episodes.
Much like prior mannequin years, contributors lowered episode funds by decreasing the share of discharges to post-acute care services and funds to those services. Not solely have been preliminary discharges to PAC services lowered, however the size of keep at SNFs additionally decreased as contributors labored with PAC companions to scale back unnecessarily lengthy SNF stays. Hospitals and doctor teams reported creating most well-liked SNF and residential well being company networks and dealing carefully with these suppliers on care protocols.
Hospitals and doctor teams additionally reported holding weekly or month-to-month calls to debate affected person outcomes and assessment efficiency knowledge. These partnerships between inpatient suppliers and PAC services are one instance of care transformation ensuing from the mannequin.
Some interviews with contributors within the bundled cost program highlighted potential avenues for CMS to proceed when it comes to incorporating bundles into ACOs, the Lewin Group report stated. Of mannequin contributors that have been additionally collaborating in Medicare ACOs, some hospitals and doctor teams reported benefits to being in each initiatives, together with having knowledge masking beneficiary care throughout all care settings, which might facilitate enhancements in affected person care. Others expressed frustration with how BPCI Superior excludes episodes for beneficiaries attributed to sure Medicare ACOs from reconciliation and felt that CMS wanted to handle these overlap insurance policies.
Within the April 2024 proposed rule updating Medicare funds and insurance policies for inpatient hospitals and long-term care hospitals, CMS proposes the obligatory Remodeling Episode Accountability Mannequin (TEAM), which builds on prior bundled cost fashions, together with BPCI Superior and the Complete Look after Joint Substitute Mannequin, the report explains. “TEAM helps CMS objectives of driving accountable care by way of 30-day episodes and integrating specialty and first care by requiring hospitals to refer sufferers with an eligible surgical procedure to major care following their hospitalization or process. As well as, CMS indicated that beneficiaries who obtain eligible care from a hospital chosen to take part in TEAM could also be in an episode no matter ACO attribution.”
This evaluation of overlap between BPCI Superior and ACO initiatives additionally has well being fairness implications. “Our findings recommend that the BPCI Superior Mannequin reached beneficiaries from underserved populations who have been past the attain of ACOs, probably as a result of variations in underlying patterns of utilization of hospital and first care companies amongst subpopulations,” the report stated. “We discovered that BPCI Superior beneficiaries who weren’t attributed to one of many Medicare ACOs examined have been extra more likely to be from an underserved inhabitants than BPCI Superior beneficiaries who have been attributed to a Medicare ACO.”
