BPCI, Bundled Payments

Moments of Clarity

Penetrating insights from Remedy's Innovation Collaborative
Baltimore, MD, October 1 and 2, 2015. 

The conference, attended by 200 physicians, executives, and transitional care leaders in Remedy’s partner universe, as well as Remedy staff and conference faculty, was widely reported to be one of the liveliest, most energetic and inspiring events of 2015. Why?
There is a sea of change afoot, and the confluence of organizations committed to the Bundled Payment for Care Improvement initiative attending the Innovation Collaborative made it clear they are ready to change healthcare. The energy was palpable, as the networking breaks and all-attendee dinner were as lively and informative as the world-class formal presentations. This post highlights the first of the meeting’s keynote speakers, Mark Caputo, Remedy Partners’ Board Vice Chairman and Cofounder, Liberty Health Partners (which merged with Remedy to become the nation’s largest BPCI convener).

Get in the wheelbarrow
The Great Blondin, daredevil of yesteryear, one day strung a tightrope across Niagara Falls. To the gathering crowd he bellowed, "Who believes that I can walk across this rope to the other side?" A hundred voices replied, "We believe!" The Great Blondin walked across the chasm on the tightrope and came back again. Then he said, "Who believes that I can walk across the tightrope while pushing a wheelbarrow?" The chorus, notable for
a single man yelling louder than the others, replied, "We believe!" The Great Blondin pointed to the man and said, "Great, then get in the wheelbarrow!" 

Mark started his speech with the story of the Great Blondin as a metaphor for the commitment Remedy and its partner organizations have made to the Medicare bundled payment program. “When it comes to bundled payments, we all got in the wheelbarrow - CMS, hospitals, SNFs, doctors.  We volunteered to join the bundled payment world; to be audited, monitored, measured and tracked; to being fully transparent on costs and quality.”
He challenged us to ask ourselves “Why are we here?” Quoting a MedPac report, Mark pointed out that “post acute care is the most challenging period for patients to navigate.” “Especially for seniors,” he added.
“What do patients want?” he asked. “They want to go home, or home with services, rather than to a facility. If they have to go somewhere other than their home for recovery, they want to know how long they will be there and what has to happen so that they can return home.” Mark followed with evidence showing that early physician follow up after hospital discharge is a key factor in reducing readmissions; that geographic variation in total Medicare spending would decrease by 73% if post acute care spending variation were eliminated; and for appropriate patients, home healthcare is safer, of higher quality and more cost effective than facility-based post acute care.
Mark pointed to the main goals of Remedy, its partners, and the BPCI program as:

  • Patients/family participate in decisions including post acute care (PAC)
  • Care is delivered care in the least restrictive site where appropriate
  • There is alignment with high performing PAC facilities
  • PAC facility length of stay is only as long as necessary
  • There is timely follow up with an informed physician/clinician
  • Avoidable readmissions are minimized

He went on to talk about traits of high performing organizations. Based on study of Remedy’s partners to date, Mark concluded that the following were keys to success
for early adopters in BPCI:

  • Decisive leadership from the senior executive team
  • Engaged physicians (including hospitalists), clinicians and case managers
  • A focus on appropriate next site of care (NSOC) selection
  • Establishment of a SNF performance network
  • Achievement of broad cultural buy-in by defining priorities, sharing success stories broadly, publishing performance metrics and widely educating clinicians and case managers

Mark articulated some of Remedy’s guiding principles. Chief among these are, “the relentless pursuit of improved patient outcomes, accountable care, transparency, testing new ideas and collaborating with CMS.”  He added, metaphorically, “We’re back in the ‘barrow,' making progress.”
Finally, Mark recounted several visionary companies to emerge from his hometown of Seattle, WA, namely Microsoft, Starbucks, Amazon, Costco, and Fred Hutch Cancer Center, which pioneered stem cell replacement therapy. “When organizations transform industries, there is a vibe, a buzz, a focus, where the noise around fades away.  They are mission driven, and in the Zone,” he remarked. “So, whether the wind is blowing, or there’s spray from the falls, or the data’s delayed, or there’s pushback from a non-performing SNF, we’re pushing that ‘barrow,' we’re mission driven, and we’re in that Zone.”

Tagged: BPCI, Bundled Payments