Overview

Perhaps the most dramatic recent development in value-based care is the announcement by HHS Secretary Alex Azar that the Center for Medicare and Medicaid Innovation is launching “new, bold” models for value-based care. Azar is a proponent of the return of mandatory models and an emphasis on providers taking downside risk. This includes a recent HHS rule that overhauls the Medicare Shared Savings Program and pushes ACOs into two-sided risk sooner. “Without real accountability, we’re just offering bonuses on top of payments that may be too high already. That’s why we have now proposed to simplify the ACO system into two tracks, requiring them to take on risk sooner,” Mr. Azar said. Azar has also said that the administration would “revisit” mandatory models that it had previously scrapped in cardiac care and said the time had come for “exploring new and improved episode-based models in other areas, including radiation oncology.” These initiatives are in sharp contrast with the actions of Tom Price, MD, the previous HHS secretary who canceled and scaled back major mandatory bundled payment programs. And more often than not the private sector follows Medicare and Medicaid’s directions in payment reform.

2018 has been a very busy year for CMS bundled payment programs with the October launch of BPCI-Advanced. It was a mix of existing variables found in the original BPCI program like the convener option but additionally introduced new elements like Outpatient bundles. CMS allowed participants to drop episodes March 1 without penalty and approximately 16% of providers dropped out of the program. This number was expected and indicates a sustained interest in bundled payment programs by the industry. BPCI-Advanced will be reopening the model for new applicants in April and they have indicated the introduction of new outpatient episodes like total knee. The new episodes are eagerly awaited by the industry!

Early analysis indicated a preference towards medical episodes like sepsis and congestive heart failure. However Joint replacement procedures continued to be a popular choice but much lower in numbers than the original BPCI model. This is probably due to the positive cost impact of the mandatory CJR model that appears to reducing CMS costs significantly.

The positive impact of the mandatory CJR model has caused CMS to consider other mandatory models like Radiation Therapy and other diagnoses. Additionally the Oncology Care Model ( OCM) continues on in its 3rd year with early results indicating a slight reduction in spending.

The CMS success in bundled payments have led to increased private payer activity in offering bundled payment contracts to providers and employers. We anticipate 2019 and onward to be a time of major activity in the bundled payment space!

With these dramatic developments in mind the Summit is offering a number of sessions on relevant topics such as a Keynote address by Pauline Lapin, MHS, Director of the CMMI Seamless Care Models Group, a keynote on private sector bundled payment initiatives by Francois de Brantes, MBA and a major presentation on the new Health Care Payment and Learning Action Network’s (LAN) Roadmap for Driving High Performance in Alternative Payment Models. In addition the Summit will offer sessions on Oncology Care and Radiation Therapy Bundles; the Use of Gainsharing in Bundled Payment Arrangements; Effective Use of Waivers in Bundled Payment Initiatives; How a Health Insurer and a Provider are Well-Positioned to Overcome the Barriers to Bundled Payment Adoption; AI, Analytics and Big Data Strategies to Drive Bundled Payment Success; Trends and Tactics in National Bundled Payment Programs: Risk/ Bundle Selection, Performance Monitoring, and Clinical Management; How Provider Organizations Can Design Clinical Pathways in the Context of Bundled Payments; Creating Better Quality Measures in APMs; Social Determinants of Health into ACO/ Risk Bearing Models; Lessons Learned and Best Practices in Value based Contracting; Enhancing the Patient Engagement and Experience in Accountable Care; Lessons Learned for Specialty APMs; Engaging Specialists in Value-based Payments through Specialty Payment Chassis Design; Methods for Managing Post Acute Care; and Integrating Behavioral Health and Primary Care into Value-based Arrangements.

But there is more. Bundled Payment Summit attendees are able to attend all sessions of the collocated ACO Summit X and MACRA Summit IV. Please see the combined Agenda-at-a-Glance on page 3 of this brochure. In combination the three events feature over 40 sessions and a faculty of over 100 national experts on accountable care, bundled payments, MACRA and its APM and MIPS components and value-based care generally.

So join us in Washington, DC to learn and debate strategies for success and best practices in the nation’s newly invigorated move to value-based care and in conjunction therewith how we can improve the quality and efficiency of care that is rendered to our patients.

— Peter N. Grant, JD, PhD, CEO, Global Health Care, LLC, April 2019

WHO SHOULD ATTEND