1.800.360.0603

GE Healthcare Camden Group Insights Blog

Don’t Blow Your Bundle Budget: Establish a Patient Engagement Workgroup

Posted by Matthew Smith on Sep 8, 2016 2:40:08 PM

By Susan Robinson, MS, Consultant, GE Healthcare Camden Group

As CMS continues to test various alternative payment models, financial success will come to those hospitals that learn to effectively engage their patients. The recent cardiac Episode Payment Model (“EPM”) is just the second mandated bundled payment arrangement with more anticipated to follow. Whereas the Comprehensive Care for Joint Replacement (“CJR”) model mandated bundling for primarily elective procedures, hospitals will have to modify their engagement strategies as the patient population associated with the medical and surgical cardiac services are fundamentally different. The unique co-morbidities, health outcomes, and lifestyle habits of each person must be accounted for as organizations partner with cardiac patients to improve their health status.

CMS added a twist to this summer’s proposal by introducing incentive payments for cardiac and intensive cardiac rehabilitation (“CR”) services. These medically supervised programs focus on exercise, education for heart-healthy living (e.g., nutrition and smoking cessation), and counseling to reduce stress; all are efforts that have been shown to promote positive patient outcomes.1 CMS will be testing this approach on hospitals in 45 of the 98 mandated geographic areas participating in the cardiac EPM along with another 45 geographic areas outside those markets. The additional payments are intended to support beneficiary adherence to treatment plans, thereby leading to improved patient outcomes. Participant hospitals are wise to take advantage of CR programs to improve adherence and outcomes. A patient engagement workgroup needs to make sure two elements get put in place: ensuring providers refer beneficiaries to CR programs as part of standard discharge protocols; and utilizing care navigators to conduct post-discharge follow-up on participating patients.

If your organization hasn’t already dedicated resources to focus on patient, family, and caregiver engagement, then there’s no better time than….well, yesterday. Regardless of whether your organization’s patient engagement work group is an extension of another initiative or is designed specifically to prepare for cardiac EPM participation consider these 5 elements for success.

1. Involve the Right People

The workgroup should represent the key departments that serve cardiac patients such as the medical and surgical cardiac service lines, cardiac rehab, nursing, care management, nutrition, social work, pharmacy, and primary care. Adding the voice of a patient advocate or a recent patient who experienced cardiac care within your hospital can pinpoint the main determinants critical to actively engage patients in their care. When forming the team, don’t forget to look outside your organization to preferred post-acute and community partners—their involvement can help strengthen relationships and help keep patients accountable. Leverage IT and marketing for support to enhance the team’s ability to tap into other organizational capabilities.

2. Shape the Vision & Define Deliverables

Patient engagement efforts should constantly be evolving based upon feedback loops. Establishing a patient focus group to determine what went well, what didn’t go well, what they’d like to see improved based upon their previous experience is one way an organization can understand the patient’s experience and identify critical points in the episode to enhance patient engagement. With target prices and potential payments set by CMS on a quality first principle, the workgroup must understand the quality measures upon which reimbursement is based: CABG and AMI mortality, readmission rates and patient satisfaction scores. Incorporating other institutional measures of patient engagement, experience, or activation will help the team determine where to spend their time to make the most impact. As the goals and objectives of this workgroup may closely align with other population health strategies, it is important to define the desired deliverables in the context of organization priorities.

3. Focus On the Complex and High Risk

The roles and responsibilities of resources such as care navigators need to be prioritized. They will be accountable for developing and monitoring adherence to patient care plans, including follow-up appointments with cardiologists and primary care, but a significant amount of their attention should be focused on the higher risk patients in order to keep costs of readmissions down. Defining a process to identify high risk patients through risk stratification tools and learning how to best automate it should be a responsibility of this group supported by data and analytics. It will be important to understand the risk factors and reasons for potential noncompliance to treatment plans (e.g., medication, dietary, exercise regimes) specific to this population and how these factors can be mitigated.

4. Use the Patient Incentive Waivers

One hospital’s focus group highlighted how the lack of transportation to CR programs kept patients from participating.2 A hospital who experienced this same problem now provides patients with access to mobile applications to monitor progress after they leave the hospital. 3 Patients are able to log their exercise routines and receive reminders to take medications at prescribed times. The patient’s information is tracked on a clinical dashboard by their care team allowing them to intervene as necessary. Participant hospitals should take advantage of patient incentive waivers under the EMP to provide innovative technological solutions, but be smart and start by exploring the capabilities of current technologies within your organization.

5. Measure

The workgroup must design and deliver the strategy to monitor patient engagement efforts. Hospitals should as themselves the following questions. Are we giving our patients what they need to be successful? Are care plans aligned to patients’ health goals? Have we provided our patients the appropriate tools so they don’t end up back in the hospital? Are hospital staff and their partners effectively tracking the patient and their compliance to treatment, medication, and rehab plans throughout the entire episode of care? Not only should the key measures of success be monitored but they must also be communicated regularly to senior leaders and operational staff to illustrate the impacts of their efforts.

The investment in well-crafted strategies will pay for itself as highly engaged and accountable patients are critical to population health efforts. Patients who have positive experiences with your hospital are more likely to become a partner and loyal to your organization when it comes to receiving care and recommending your services.    

  1. http://www.heart.org/HEARTORG/Conditions/More/CardiacRehab/What-is-Cardiac-Rehabilitation_UCM_307049_Article.jsp#.V8BftvkrLcs
  2. http://www.hfma.org/Leadership/Archives/2016/Summer/Collaborating_Around_Bundled_Payments/
  3. http://www.healthcarefinancenews.com/news/new-technologies-hospital-strategies-promote-patient-engagement

Robinson_Susan.pngMs. Robinson is a consultant with GE Healthcare Camden Group, specializing in bundled payments, process improvement, workflow redesign, value stream mapping, and time efficiency studies. Prior to joining GE Healthcare Camden Group, Ms. Robinson served as an industrial engineer for New England Veterans Engineering Resource Center in Boston, Massachusetts, where she applied systems engineering approaches to a variety of healthcare problems. She may be reached at susan.robinson@ge.com.

 

 

Topics: Bundled Payments, Cardiac Care, Episode Payment Models, Susan Robinson

Preparing for Episode Payment Models—Next Up: Cardiac Care Bundled Payments

Posted by Matthew Smith on Aug 15, 2016 9:53:21 AM

By Andy McNerney, Manager, GE Healthcare Camden Group

CMS’s newly proposed Episode Payment Models (“EPM”), focused on cardiac care, is the second major push to mandate the national adoption of bundled payments’ in recent years. Perhaps your organization was spared as you watched 67 other markets forced to bundle joint replacements. If your reaction was only to feel lucky that you dodged the swipe of our government’s hand instead of better preparing your service lines for episode based care delivery, then it’s time to organize regardless of which markets are selected this time around. 

These cardiac mandates have been proposed under the umbrella of EPMs, and participation will qualify physicians towards Advanced Alternative Payment Models (“APMs”) credit suggests CMS’ intention to roll out more. Although a cardiac episode presents very different challenges than a joint replacement, the way your service line approaches the episode care design, standardization, and monitoring process is very similar. If you haven’t already started enabling your service lines to execute on a bundle, don’t wait for a government dart to land in your market to do so. Instead, start developing work teams responsible to design and standardize processes across the pre-acute, inpatient, and post-acute setting as well as work teams dedicated to the reporting and monitoring of outcomes and engagement of patients across the entire episode.

The Proposed Model

Three major components make up the mandatory EPM proposal:

1. Cardiac Bundles: Inpatient admissions will be paid under a bundled payment for Acute Myocardial Infarction (“AMI”) episodes and Coronary Artery Bypass Graft (“CABG”) episodes for the next 5 years as follows:

  • Episode length: 90 days post-discharge
  • Mandated Markets: 98 random markets (rural markets excluded)
  • Downside Risks and Gains: Phased in over time and max out at 20 percent in the final years
  • Target Price: Weighted to hospitals’ historical performance in year 1 and transitions to one regional price in year 5
  • Quality and patient satisfaction scores influence financial gain or downside risk

2. Cardiac Rehabilitation (“CR”) Incentives: CMS will incent cardiac rehabilitation services utilization post-discharge within the 90-day episode period through retrospective payments as follows:

  • First 11 CR Services post-discharge from CABG or AMI admission: $25
  • Remaining CR Services in 90-Day Episode: $175

3. CJR Addition: Surgery for Hip Fractures was added to the current CJR mandate and will only immediately affect those hospitals in CJR mandated regions.

Not surprisingly, the proposed cardiac bundles are designed with very similar objectives to the CJR bundles: reduce unnecessary utilization such as readmissions, incent discharge placement to the appropriate care setting, promote care coordination across providers, and improve quality through care model design and standardization. As such, organizations embracing this cross-continuum care delivery work for the first time should start by establishing work groups that represent the following four areas:

  • Inpatient Clinical Redesign: While some patients present as non-emergent cases, many are through the emergency department when episode expectations can’t be set in advance, as is done with pre-surgical joint placement classes. These cardiac episodes contain both surgical and medical care making physician engagement even more important. Form a work group now that identifies opportunities to improve quality and develop a standardized care approach. Consider the following representatives: cardiovascular surgeons, cardiologists, hospitalists, case managers, social workers, operating room leadership, supply and implant purchasers, emergency room physicians, and a strong physician lead driving change.
  • Post-Acute Care: Similar to CJR, a work groups’ time should be spent standardizing discharge placement protocols and identifying preferred providers (SNF, HH, IRF, Cardiac Rehab providers, and others) who commit to sharing data, adhering to best practice protocols, and meeting quality requirements. Much more important for cardiac bundles will be transitioning patients back to OP partners and processes dedicated to managing the chronic conditions that led to the original admission. Consider the following representatives: Post-acute care managers, SNFists, Cardiac Rehab clinicians, inpatient case managers, cardiac services line leaders, and other care coordinators.
  • Quality and Reporting: Monitoring your bundle performance as real-time as possible and ahead of the quarterly report from CMS will keep your care teams engaged and promote a culture of continuous improvement. Utilize representatives from finance and data / analytics to research dashboards and tools that help identify care delivery and cost variation and allow care coordinators to identify and track bundle patients in your system.
  • Patient Engagement: One major variable differs greatly to the CJR bundle—the patient population. Unlike an elective joint patient, this population has greater co-existing chronic conditions and will naturally have more unplanned services and complications which make achieving your objectives more unpredictable. Successfully engaging patients can make the difference and justifies the need for establishing a patient engagement work group. This work group should take a more social view and identify programs and tools to assist with adherence to treatments and medication management, compliance with Cardiac Rehab care plan and follow-up appointments, adherence to dietary and nutrition regimes, and social support services. This group may be an extension of other population health initiatives identifying high risk patients through risk assessment tools and empowers them with tactics and technologies to manage their recovery and prevention.

We recognize that resources are scarce, competing initiatives are many, and establishing work groups and initiatives without an actual mandate or direct incentive can be a tough sell. If you are not able to organize your operations and select service lines around the above work teams for the simple reason that it’s best for patients in your community, then do so under the assumption that bundles are here to stay, and the works needs to get done to succeed within them.    

Cardiac Care Bundled Payments


mcnerney.jpgMr. McNerney is a manager with GE Healthcare Camden Group. His primary area of focus is bundled payments strategy, design, and implementation. Mr. McNerney also specializes in system and service line strategic planning and new business development for a variety of healthcare organizations. He may be reached at andrew.mcnerney@ge.com 

 

 

 

Topics: Bundled Payments, CMS, Andy McNerney, Cardiac Care, Episode Payment Models

Subscribe to Email Updates

Value Model, Health Analytics

Recent Posts

Posts by Topic

Follow Me