Bundled Payments for Care Improvement (BPCI) Alliance for Health Reform Capitol Hill Briefing Jim Garnham Dir. Contracting & Payment Innovation University of Rochester Medical Center

What is a Bundled Payment in BPCI? Single budget for an episode of care  Medicare FFS enrollees only  Voluntary Participation  Defined Episodes of Care: –Starts with anchor hospitalization –Inpatient, Outpatient, Physician, Nursing Home, Home Health, etc. –Covers a defined time period (e.g. 90 days post discharge)  Calculated budget (BPCI term is “Target Price”)  Retrospective payment reconciliation 1 * Required Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Assessment of Opportunity Our criteria for selection of BPCI Clinical Episodes  Volume  Variation  Vision Used data and an internal “RFP” to assess Chose: 1.Major Joint Replacement – Lower Extremity 2.Congestive Heart failure 2 Is it worth doing? Can we do it?

Opportunity: Skilled Nursing Facility Rehab 3

Opportunity: Readmissions 4

Key Resources, Processes  Clinical Pathways –Inpatient –Post-acute – reviewed with partners: Geriatrics, Home Care, Skilled Nursing Facilities  Dashboard –Identifies & tracks patients throughout episode  Care Navigator –Primary responsibility for following patient –Coordinates services, transitions, etc. including with SNFs, PCP offices, Specialty offices, Home Care  Enhanced Home Care –Rehabilitation for Major Joint Replacement –Rapid Response visits for Congestive Heart Failure 5

Early Results – Major Joint Replacement 6

Early Results – Congestive Heart Failure 7 * Patients with one or more readmissions

An Important “Spillover” Effect Positive Externalities to Multidisciplinary Teams  Connections/conversations/information transfer that has never happened before  Desire to apply same, similar resources to non-BPCI patients –Clinical Leadership –Administration 8

Contact Info Jim Garnham Director, Contract & Payment Innovation University of Rochester Medical Center (585)