Darcie Hurteau has worked in the healthcare industry for more than 15 years. For the last 10 years, Darcie has helped hospitals and other healthcare providers understand changes in Medicare's reimbursement systems. As Director, she leads the DataGen team that provides decision support and education to hospitals and health systems across the country as they prepare for health reform payment strategies. Darcie started her career in healthcare finance at Albany Medical Center in Albany, New York.
Healthcare organizations face a daunting challenge when it comes to managing alternative payment models (APMs). They must become better at care management to reduce utilization and costs. Success requires commitment, but affords the opportunity for healthcare organizations to implement real delivery system reform.
That’s why bundled payment programs are so promising for healthcare organizations. Of all payment models, they have had the biggest impact on delivery reform. Smart organizations are learning that early participation—preferably when these programs are still voluntary—can give them a critical head start that will continue to reap benefits over the long term. Experience has shown that most voluntary CMS payment programs become mandatory, so organizations that wait to participate risk falling behind.
With an effective strategy and an appropriate understanding of how to make the most of these programs, participants can help their healthcare organizations emerge as market leaders.
In many ways, voluntary programs are a gift from CMS to hospitals and health systems—especially when considered in the light of new, compounding market pressures. Fee-for-service-focused organizations that have been delivering services in nearly the same way for 40 years are simply not equipped to compete with urgent care clinics or to attract patients with a consumer-driven mindset. Nontraditional players such as Amazon and Apple, among countless others, are poised to fundamentally change the way care is managed and delivered. Healthcare organizations that don’t adjust will be left behind.
Voluntary programs help transform provider behavior to meet the new challenges. In a bundled arrangement, providers can’t afford to be passively engaged with patient care. Bundled payment models force additional focus on pre-procedure and post-procedure patient care to enhance quality outcomes and avoid complications and readmissions. The experience gained by participating helps organizations stay ahead of new mandatory programs, while improving workflow and enhancing care quality and outcomes.
These programs also enable participants to provide input on an APM based on real, on-the-ground experience. As participants gain experience and develop best practices, they become an incredibly valuable resource for CMS, since they can offer unique insight on the program’s benefits and drawbacks.
That also helps providers become more actively engaged in the longitudinal care of their patients. Rather than passively engaging in episodic care, they begin to follow their patients through the continuum of care and can start to see how their care decisions impact patients in the days and weeks following a procedure.
Thriving in a bundled program, whether mandatory or voluntary, requires the right sort of preparation and a strong strategy. Here are 4 key areas to focus on to achieve positive results:
Our advice is simple: if CMS offers a voluntary program, take advantage of it. If nothing else, it can foster self-improvement in the delivery system—and it’s generally a safe bet that what’s voluntary today will be mandatory tomorrow. When it comes to rationalizing the cost of participation, keep an eye on the long game. Don’t wait—take advantage of the benefits of bundles.