Maximizing Earnings in BPCI-A: Post-Acute Care partnerships

What are the most important strategies for maximizing earnings in bundled payment programs, such as Medicare’s Bundled Payments for Care Improvement Advanced (BPCI-A) program? This post will focus on building strong post-acute care (PAC) partnerships and will explain how to use your BPCI-A historical data to choose and improve these partnerships.

Partnerships between physicians or hospitals and PAC facilities can benefit both parties in many ways. For example, benefits can include:

• Improved coordination and communication between the PAC and the physician/hospital, such as allowing the physician/hospital or their care coordinators to contact the PAC to check on their patients’ status, or providing advanced notification to the PAC that a new patient is incoming
• Sharing of patient data so that all providers have as much information about the individual patient as possible
• A commitment by the PAC to keep the patient at their practice only as long as they clinically require that level of care, leading to better patient outcomes and lower costs
• Sharing of outcomes and quality data so that providers can understand what happens to patients after the leave their care
• Sharing in any financial savings driven by the partnership. In BPCI-A, the physician group practice or hospital can share in the savings, or “gainshare”, with PAC facilities, providing strong incentives to improve care quality and reduce spending.

The first step in building strong PAC partnerships is determining how important PAC is to your patients or episode types. Certain episode types — such as some orthopedic episodes — have a large share of episode spending coming from PAC, and these episodes are the most likely to benefit from PAC partnerships.

Next, identify which PAC facilities your patients are using most, as this will help you choose which facilities with which to partner. Many practices we’ve worked with have been surprised to see which PAC facilities are most commonly used by their patients — and how many different facilities their patients use.

After identifying which episode types and PAC facilities are the best for partnerships, meet with the facilities to discuss the program and formalize agreements. To help introduce BPCI-A, CMS has some provider-oriented summaries on the BPCI-A website, or you can use third-party information such as SimplyVital Health’s “Introduction to BPCI-A” webinar (register here) or our “Reasons to Participate” Medium post. It’s important to highlight how the partnership can benefit the facility, such as the reasons outlined above. A signed agreement can make it official and help avoid misunderstandings in the future. (Remember that in BPCI-A, if you plan to share in the savings with the facility, it is required that you have financial agreements in place that meet the BPCI-A “Participation Agreement” specifications and that you include the facility on your quarterly “Financial Arrangements List” (FAL).)

Of course, regardless of any partnerships that are discussed and formalized, the patient must always have the freedom of choice to pick any facility. Providers can share information about different facilities and make recommendations, but the decision is ultimately up to the patient.

Stay tuned for more posts about maximizing earnings in BPCI-A!

Though BPCI-A and maximizing earnings can seem like a daunting task, SimplyVital Health has the expertise and infrastructure to provide the support you need through our modular sana program. Created by a former hospital administrator and data science team with direct experience succeeding in bundles, we provide multiple concierge services including actionable analytics, post-acute care strategy, care coordination, a collaborative coordination platform, and stop-loss insurance. For more information, contact us through our website at https://www.simplyvitalhealth.com/.

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The information provided on this website does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available on this site are for general informational purposes only. Always ensure compliance with BPCI-A Participation Agreement and other documentation and communication from CMS.