Industry Roundtable: Ongoing Innovation Will Drive Bundled Payment Models
Thought leaders from CMS, Clarify Health Solutions and Mount Sinai Health System predict a bright future for bundles with the right approach to change management
Chasm Partners (@ChasmPartners) recently convened an industry roundtable of healthcare thought leaders to evaluate both the current state and future of bundled payments. The discussion’s participants included:
- Patrick Conway, deputy administrator for innovation and quality and director of the Center for Medicare and Medicaid Innovation (CMMI) and Centers for Medicare and Medicaid Services (CMS)
- Jean Drouin, MD, CEO and co-founder of Clarify Health Solutions
- Niyum Gandhi, executive vice president and chief population health officer of Mount Sinai Health System
Today, approximately 1,300 hospitals, physician groups, and post-acute providers nationwide participate in CMS’ voluntary Bundled Payment for Care Improvement (BPCI) model. These providers are redesigning and improving care delivery for one or more of 48 conditions. Commercial payers also are starting to align with CMS’ bundle definitions as healthcare continues to undergo a transformation in both payment models and care delivery.
Chasm Partners, an executive search firm, hosted the roundtable as part of its quarterly newsletter, ChasmPOV. Managing Partner, Matt Dumas commented, “With so much legislative attention in Washington focused on access to medical care, the industry is wondering about areas of healthcare reform that are already underway. Bundled Payments is clearly one of those important areas.”
Key takeaways from the roundtable included:
- Bundled payments are an innovative alternative payment model that needs to be supported by other forms of innovation to be successful. “We have been impressed by the level of engagement of providers in bundled payments…the amount of innovation in the marketplace focused on better patient care is exciting,” Conway said. “For example, providers are using evidence-based protocols and team-based care to guide decision-making. Providers are using data and risk assessment to determine the best setting for post-acute care. We are seeing providers use telehealth and home care in innovative ways to support patients in their homes.”
- Providers need to be rewarded for supporting value-based care—and you can’t reward what you can’t measure well. “Bundles are a tremendous improvement over fee-for-service by providing a standardized yardstick to track and assess value,” Drouin said. “But it’s important to remember that the purpose of bundles is not to lock down care to a few set pathways, but rather to provide a language to facilitate the identification of positive and negative practice patterns—and to reward clinicians and providers based on value creation.”
He added: “The better and richer the data available, the more sophisticated the predictive analytics can be to validate good variation versus unhelpful practice.” The San Francisco-based healthcare technology company that Drouin leads, Clarify Health Solutions, is focused on providing predictive analytics and real-time workflow solutions for episodes of care, including bundled payments.
- Even within the context of high-value innovation, providers must fully understand and embrace the operational improvements required to drive outcomes under bundled payments. “For bundles with significant post-acute spend, integrating pre-operative navigation with hospital case management and discharge planning is critical,” Gandhi said.
In addition, he explained that for bundles that have high spend on implantables or devices, there will likely be a greater focus on managing sourcing and variation. “If a bundle includes the ability to shift site of service—such as an orthopedic bundle that triggers based on the surgery irrespective of whether it occurs inpatient or outpatient—then demand-matching and all of the associated analytics and navigation become most critical,” Gandhi said.
Drouin explained why innovation and operational improvements are inextricably linked, especially in a healthcare setting. “In contrast to industries such as logistics or retail, providers have only begun to unlock the benefits of episodic care model and workflow redesign, which demands a different approach and mindset. Bundles necessitate quarterbacking far beyond the confines of the hospital EMR, across multiple care sites, including the home.”
Doing that successfully requires the implementation of a technology platform to enable automated systems of longitudinal engagement, “where the patient is monitored and piloted from the beginning to the end of the bundle journey,” Drouin added.
About Clarify Health
Clarify Health believes that patients and those who care for them deserve better. Our digital solutions seamlessly integrate predictive analytics, artificial intelligence, real-time patient navigation and smart workflows to proactively guide patients and their caregivers through more precise and personalized care journeys. The result for providers, payers, employers and patients is more satisfying, higher value healthcare—and better outcomes. Clarify Health brings together committed and passionate colleagues with backgrounds in big data and AI engineering from financial services together with extensive clinical operations expertise.
About Chasm Partners
Chasm Partners is a retained search firm focused on placing top talent in high-growth venture backed companies. We specialize in helping organizations scale in highly disruptive sectors facing transformation including Healthcare Technology & Services, Big Data & Analytics and Enterprise Software. In addition to retained search, Chasm invests in many of its clients and provides additional services to help them scale and grow including organizational build-out, leadership development as well as business development.