The Centers for Medicare and Medicaid Services (CMS) recently released the final rule for Advancing Care Coordination Through Episode Payment Models (EPMs); the Cardiac Rehabilitation Incentive Payment Model; and changes to the Comprehensive Care for Joint Replacement Model that finalize bundled payment models for certain cardiac conditions and procedures in select geographic areas.
The goal is improving the efficiency and quality of care for Medicare beneficiaries and encourage hospitals, physicians, and post-acute care providers to work together to improve the coordination of care from the initial hospitalization through recovery.
These new payment models require much closer coordination among hospitals, physicians and the post-acute support providers needed to get patients healthier at a lower cost with equal or better quality. Although some physicians and hospitals have had time to get ready for bundled payments, most still need to go through practice and workflow transformation to deliver on the anticipated outcomes.
As earlier CMS demonstrations and private payer models have demonstrated, the underpinning to success will include data and analytics to inform the change process as well as the outcomes. For example, both the Medicare Acute Care Episode demonstration and a bundled payment program at a private hospital system relied on data to support reporting that provided transparency around quality measures and cost.
When you consider that these models of care require post-discharge coordination not only with PCPs and specialists, but with inpatient rehabilitation, skilled nursing facilities, home health agencies, outpatient rehabilitation, lab and imaging, that’s a complex network of relationships and data. What’s really needed is bundled data – bringing together all of the patient’s health information for that episode of care. Since the payment for services under the episode is bundled around the patient, it makes sense that the data must be as well.
Although clinical EHR and claims data act as a starting point for understanding clinical outcomes and cost, what’s really needed is a health informatics platform that can securely connect health data across settings of care, integrate disparate data types (clinical, claims, lab, pharmacy), while supporting provider workflow. Key coordination processes include:
- Access to an electronic summary of care record, allowing providers, case workers, care managers and others involved in the patient’s care to view key health information including care plans.
- Alert notification for a patient readmission into a hospital.
- Secure messaging between providers of service to streamline transitions.
- Access to both pre- and post-operative lab results and imaging studies.
Whether we like it or not, value-based payment models are here to stay. Many healthcare organizations (HCOs) are still grappling with how to leverage their data assets. So, what should they do to prepare, if they haven’t already started down the path?
My observation has been that some of our clients are using our health informatics platform to “bundle” the data around their patients, and they are among those who will see success in these new payment models. I recommend that HCO leaders start to build the data management foundation the allows them the flexibility and agility to navigate the new models of care.