Bundled Payments: Time to Reset and Realign

Key takeaways:

• As we emerge from the COVID-19 pandemic, bundled payments offer healthcare providers opportunities to improve performance and generate savings.
• PINC AI™ data shows that readmissions continue to be an area of untapped savings.
• Five areas of focus can help providers reset, realign and drive positive results within bundled payment programs.

For more on this topic:

• Learn about the benefits the PINC AI™ Bundled Payment Collaborative can offer your healthcare organization.
• Check out Premier’s population health consulting capabilities.

The Miriam Webster Dictionary defines 'reset' as: “a verb that can mean to adjust or fix in a new or different way: to reset priorities.” As we emerge from the COVID-19 pandemic, many healthcare providers are refocusing on bundled payments and opportunities to improve performance and generate savings. The challenge is identifying where to start the “resetting” effort.

A good first step is to review program data and pinpoint opportunity areas. The PINC AI™ Bundled Payment Collaborative’s readmission data (Figure 1) shows that readmissions continue to be an area of untapped savings. Looking closer at the data, 30 percent or more of the total readmissions for the highest volume service line groups (medical and critical care, cardiac care and neurological care) are to a provider other than the anchor facility (other admit).

Figure 1: PINC AI™ Bundled Payment Collaborative, BPCIA BPIP, Completed Episodes Only, Episodes with COVID-19 Diagnosis Excluded, PP3-PP4 Episodes

Further, data shows that for most medical and critical care episodes, patients are readmitted with a diagnosis of sepsis or with the same discharge diagnosis from the anchor facility. The data also shows that the higher readmission rates occur in post-discharge days 1-7 and after day 30.

Figure 2: PINC AI™ Bundled Payment Collaborative, BPCIA BPIP, Completed Episodes Only, Episodes with COVID-19 Diagnosis Excluded, PP3-PP4 Episodes

Given these findings, key focus areas to include in a “reset” strategy are:

1. Reviewing and updating clinical protocols and pathways with a particular focus on care transitions and hand-offs to all post-discharge providers.
   
2. Ensuring discharge instructions are standardized, well understood by all post-discharge partners and communicated to accommodate for the patient’s learning style, social determinants and health literacy needs.
3. Expanding primary care and specialty care coordination efforts to include communication about the patient’s plan of care for (including medication regimen) for a minimum of 90 days, particularly for high-risk conditions such as sepsis, pneumonia and congestive heart failure.
4. Increasing focus on home health and other PAC utilization with the goal of realigning and rebuilding partnerships. Partnerships may need to be supercharged through competency assessments that include on-site visits; services, staffing and capacity reviews; and quality data reviews.
5. Improving patient engagement tactics, such as telehealth practices, and consumer requirements to meet the patient’s needs and desires.

“It’s time to realign with our partners, especially in the post-acute space. Our post-acute partners have suffered from the same ‘mass casualty mode’ we as health systems have been in for two years now. Never have we seen a ‘mass casualty’ last this long or rise and fall the way the COVID-19 pandemic has. With the constant strain on our resources and people over such a prolonged period, it is no surprise that our everyday processes, even those hard-wired, have suffered. As we have adapted to new COVID infrastructures, and as COVID-19 volume has slowed, we find ourselves resetting many processes that took a back seat during the pandemic.

Our partnerships with post-acute facilities are key. It really starts at the basics which means making our time together a priority again and extends to creative and innovative ways to partner going forward. Asking ourselves questions like: What resources do we have collectively? Where are there gaps? What communication methods and sharing of information real time are in place? What protocols need to be revised or developed? How do we hold ourselves accountable to the partnership?

All these questions need to be answered. There is so much opportunity and we’re excited for where our partnerships can take us.”

– Ashley Stine, Vice President, Clinical Outcomes, University of Florida Health, Central Florida, and a member of the PINC AI™ Bundled Payment Collaborative

Healthcare organizations have shown their ability to quickly adapt during the pandemic. Now is the time to reset priorities and focus on those areas that impact overall savings, care delivery and patient satisfaction to drive positive results within bundled payment programs.

The insights you need to stay ahead in healthcare: Subscribe to Premier’s Power Rankings newsletter and get our experts’ original content delivered to your inbox once a month.