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Legacy will participate in new CMS bundled payments model

Earlier this year Centers for Medicare and Medicaid Services announced a new voluntary episode payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced), that will provide incentives for participants who reduce spending while improving quality of care in 32 clinical episodes. The program begins on October 1, 2018 and will run through December 31, 2023.

Legacy Health has been accepted for participation in the program. LHP providers may see some patients that are in the program either during outpatient follow-up or during the hospital stay for a few specialties. This focus on post-acute setting will have downstream impacts and benefits, including in the home health and skilled nursing facility settings. It could also help with future Medicare Advantage contracts.

How will the BPCI Advanced model work?

BPCI Advanced will evaluate total cost of care for Medicare fee for service beneficiaries during the 90-day clinical episode and compare this to a predetermined target price for payment reconciliation. The target is specific to the participant and based off historical spending as well as other risk-adjustment factors, so participants are working to continuously improve upon their own performance. Because BPCI Advanced qualifies as an Advanced APM under the Quality Payment Program, payment is also tied to performance on quality measures.

Legacy Health applied as a convener participant and listed all six hospital sites as Episode Initiators under its convener umbrella. This means that Legacy is will be responsible for all clinical episodes that are triggered by a procedure or inpatient stay at any of its hospitals. Legacy applied for all clinical episodes where performance was already better than the target or there was significant financial opportunity.

Most of the opportunity to reduce cost of care is in the post-acute setting. For this reason, care management has been engaged to create a care model to manage post-acute care and reduce readmissions for the chosen episodes. There is an opportunity in March 2019 to withdraw from clinical episodes, so we will evaluate performance at that point in the performance period and decide with episodes to move forward with for the remainder of the program.

Who will be most impacted?

Based on the initial episodes Legacy has chosen to participate in, we anticipate that cardiology, gastroenterology, neurology and hospitalists will be the specialties most impacted. Also, because the episodes extend 90 days past the triggering procedure or admission, primary care and specialists will play a big role in managing these patients. We will follow up with these groups of providers separately with more information on the program.

Resources and more information about the program:


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