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Bundled Payment Initiative: Your time to get ahead of the crowd? Paul Lee, Sharon Cheng, Marian Lowe Strategic Health Care September 29, 2011.

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Presentation on theme: "Bundled Payment Initiative: Your time to get ahead of the crowd? Paul Lee, Sharon Cheng, Marian Lowe Strategic Health Care September 29, 2011."— Presentation transcript:

1 Bundled Payment Initiative: Your time to get ahead of the crowd? Paul Lee, Sharon Cheng, Marian Lowe Strategic Health Care September 29, 2011

2  Test new payment and service delivery models  Work across Medicare, Medicaid, and CHIP programs  Expand the scope and duration of models proven effective IF those models are proven to also lower costs.  $10B in direct spending for Facilitating Change

3 Innovation Center Projects

4  Multi-payer initiative to test new service delivery and payment models  Monthly care management fee to primary care practices, opportunity for shared savings  5-7 localities will be selected Criteria  For physicians: 60% of patients must be in participating plans & Medicare, use EHR, have at least 200 FFS Medicare patients  For plans: Commit to contracts with participating practices that offer shared savings; provide attribution methodology with CMS Deadline: LOI due November 15; Application due January 17 Comprehensive Primary Care (CPC) Initiative

5  Leadership opportunity  Align payers  Promote services  Decrease readmissions, unnecessary services  Physician partnerships 5 Reasons to Participate

6  Medicare margins are thin  You are unlikely to beat your 2009 baseline  You need funds to begin care redesign Cautions

7  Letter of intent  Model 1: October 6, 2011  Models 2, 3, and 4: November 4, 2011  Application  Model 1: November 18, 2011  Models 2, 3, and 4: March 15, 2012 Deadlines

8 Four options for participation ServicesRiskGoal Model 1Part A inpatientLow: 0-2% discount, well- defined bundle Align physicians through gainsharing Model 2Part A inpatient, Part B, including post-acute, DME, and Part B drugs Medium: 2-3% discount; 30, 60 or 90 day complicated bundle Offset revenue lost with reduced readmissions, other improvements Model 3Post-acute Part A and B, including DME and Part B drugs High: 2-3% discount; long, undefined bundle Offset revenue lost to lower-intensity post-acute care Model 4Part A inpatient and professional services during the stay Medium: 3% discount; short, discrete bundle Align physicians, reduce inpatient costs

9  Gainsharing Demo  MedPAC and CBO models  CARE tool research  ACE Demo Have we seen this unicorn?

10  CMS will provide dataset of fee-for-service Medicare claims, 2009  Use clinical logic to define related claims and choose the length of the episode  Determine bid amount  Propose quality measures Designing the bundle

11  Offer significant savings  Affect many beneficiaries and conditions  Scalable and replicable  Include other payers  Incorporate IT  Are “shovel ready” Strong applications

12  SHC can help prepare you for bundling  Evaluate your readiness to participate  Prepare the letter of intent  Prepare the data use agreement and work with you to analyze CMS administrative data  Prepare or review and provide feedback on applications For Assistance Gwen Mathews, Partner Strategic Health Care Opportunities for assistance


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