The goal of this case study is to offer insights into preparing for and managing innovation in health care payments, which may be useful to other organizations as they navigate their own path through health care reform.
ALBANY, N.Y. (PRWEB) September 04, 2013
A case study released by DataGen and NewYork-Presbyterian Hospital (NYP) examines the challenges, opportunities, and lessons learned to date from Medicare’s Bundled Payments for Care Improvement (BPCI) initiative.
“After working with NewYork-Presbyterian Hospital and other hospitals around the country for nearly a year, we identified a number critical success factors for BPCI and other payment innovations,” said Gloria Kupferman, Vice President, National Information Products, DataGen. “This case study is based on what we’ve learned, and incorporates the experience and perspective of one of the nation’s leading academic health centers. The goal of this case study is to offer insights into preparing for and managing innovation in health care payments, which may be useful to other organizations as they navigate their own path through health care reform.”
In January 2013, the Centers for Medicare and Medicaid Services (CMS) announced the 450 health care organizations selected to participate in the BPCI demonstration project. The goal of BPCI is to evaluate the use of bundled payments in supporting the delivery of high-quality, coordinated care at lower costs for Medicare. Under BPCI, organizations are entering into payment arrangements that include financial accountability for episodes of care.
“By engaging in BPCI, we believe we can gain experience in more effectively and efficiently treating patients as well as better coordinating the care of patients during the 30 days following discharge,” said Emme Levin Deland, Senior Vice President, Strategy, NYP.
The key lessons learned by DataGen and NYP include:
- Data are essential for success. Understanding data is critical for BPCI success because it provides the basis for determining reimbursement and evaluating performance and payment. However, providers have limited experience reviewing, validating, and analyzing Medicare claims data.
- It is important to determine which episodes offer providers the greatest opportunity. Health care providers need to closely examine the data to understand the variation within episodes and individual Diagnosis Related Groups, as this will help identify savings opportunities and financial risks.
- Engaging physicians is key. Because physicians are key partners in both payment innovations and care redesign, their active engagement is a top priority.
- Influencing the utilization of post-acute care services will have a significant impact on a health care organization’s success. An organization’s ability to influence post-acute care choices can have a major impact on reducing variation, particularly in regard to readmissions.
- Patients need to be engaged. Patient behavior and engagement play a key role in improving outcomes and managing costs.
Lessons from the Field: Payment Innovation and Clinical Transformation, which expands on these and other learnings, is featured in the August 19th issue of Modern Healthcare magazine, and is also available for download on the Modern Healthcare and DataGen websites.
DataGen, http://www.datagen.info, an affiliate of the Healthcare Association of New York State, is partnering with hospitals in New York and across the country to mitigate potential risks and capitalize on the opportunities offered by bundled payment initiatives. Through its analytics services, DataGen is working with hospital partners to effectively utilize the CMS data to identify variation in patient conditions and payment, develop pricing strategies, compare performance, and monitor progress. DataGen is located near Albany, N.Y.
Based in New York City, NewYork-Presbyterian Hospital is the nation’s largest not-for-profit, non-sectarian hospital, with 2,589 beds. It has more than two million inpatient, outpatient, and lab visits in a year, including more than 251,372 visits to its emergency departments. The more than 6,000 affiliated physicians and 19,376 staff provide state-of-the-art inpatient, ambulatory, and preventive care in all areas of medicine at six major centers.