Voluntary Today, Mandatory Tomorrow: The Value of Early Bundled Payment Participation

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.

Why participate now?

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.

Strategies for success

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:

1. Find and empower a program champion. Having someone who supports, encourages, motivates, and drives bundled payment success is a must. This person may take the form of a clinical, transformational care or a “C-suite” champion. A clear return on investment may be a year or more in the making and significant investment is needed, so having an effective steward in the right place for the program can help providers and leadership see and celebrate some of the smaller victories along the way. That includes better long-term patient engagement and satisfaction and improved clinical outcomes. Reducing spending and increasing savings is just one of the benefits—and it may not even be the primary benefit.
2. Get buy-in from leadership across the organization. An organization must be committed to evaluate its clinical pathways and modify where needed. People across the organization must be committed to the program’s success, and must be willing to do the hard work to improve care coordination, identify a preferred network and manage the process through completion. That requires a true team mentality across the organization; be sure leadership has the tools and resources necessary to foster that commitment to team-based success.
3. Build effective infrastructure for staff and data. As some bundled programs become more sophisticated, like the Oncology Care Model and Bundled Payments for Care Improvement (BPCI)-Advanced, it is critical to have effective technical, clinical, and organizational infrastructure in place. Even if the organization isn’t currently participating in a bundled payment program, building the right infrastructure to thrive in value-based initiatives is a smart move.
4. Embed the program’s goals in the culture. As stated, benefits of participation in a bundled program extend beyond finances. These programs are designed to change the way care is delivered and transform the healthcare delivery system so care is high quality and high value. For example, consider how important high-value cultures are for the most successful ACOs—a lesson that participants in bundled programs should take to heart. Make sure that the entire care team understands that what they’re doing contributes to better health outcomes and creates a stronger healthcare organization at the same time. By embedding that mission and mindset into the culture, organizations can ensure that staff across the organization understand the tangible and intangible value that bundled programs can offer.

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.