Whether Mandatory or Voluntary, Bundled Payments Depend on Patient Activation

Posted by Deirdre Wilson on Jun 19, 2018 1:32:01 PM
Deirdre Wilson
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Mandatory bundled payment programs for joint replacement offer “more robust, generalizable evidence” than voluntary programs. That’s the main finding of a new study of data from Medicare and the American Hospital Association Annual Survey.

And yet, with the never ending, constantly shifting priorities that hospital staff need to balance, the implication that mandatory bundled payments might be better is a tricky one. This study does not claim definitively that they are. Rather, the authors state, there’s a place for both types of programs in the push to get more hospitals using bundled payment plans. 

The study highlights that the shift to value-based care, particularly in orthopedics, is going strong. The Centers for Medicare and Medicaid Services (CMS) wants to move this transition forward with bundled payments. Whether mandatory or voluntary, it’s wise to proactively get ahead of CMS’s efforts by implementing a patient activation solution that puts you in control.

CMS began introducing bundled payments – a set amount of money provided for hospitals to manage a patient’s entire episode of care – as a way to incentivize better care quality and lower costs.

Authors of the study, which appears in Health Affairs, looked at data from two joint replacement bundled payment programs. One is voluntary, Bundled Payments for Care Improvement initiative (BPCI), and one is mandatory, Comprehensive Care for Joint Replacement (CJR).

Get 5 top tips for succeeding with Comprehensive Care for Joint Replacement.

The authors find no evidence that hospitals in the mandatory program were at a disadvantage compared to hospitals in the voluntary program. That conclusion is sure to draw skepticism from hospital leaders who are feeling the strain of mandatory programs, which hold hospitals accountable for outcomes and costs through discharge and recovery.

But the truth is that your hospital is unlikely to meet the goals of either program without a strategy for activating patients to be more educated, engaged and satisfied. Patient activation solutions offer a far less burdensome way to work toward the outcomes sought by bundled payment programs by allowing you to:

  • Connect with patients outside hospital walls – Delivering health information and reminders on their mobile devices helps patients remember and follow your care instructions, so they don’t have costly complications, readmissions or cancellations
  • Start communicating earlier in the care episode and stay in touch longer –
    Communicating early in the care episode lets you set expectations, ease anxieties and influence care decisions such as discharge destination, all of which promotes better patient outcomes and reduces discharges to costly skilled nursing facilities for those who are able to recover at home.
  • Build stronger relationships with patients through digital connections
    Connecting with patients in their daily lives builds trust that drives patient referrals and retention, and increases HCAHPS scores.
  • Manage the care episode including and beyond what CMS requires –
    CMS is asking hospitals to manage an even longer care episode than ever before. You can impact this longer timeline automatically through technology.

If you’re hoping bundled payments will slowly fade away, they probably won’t. What’s more likely is that CMS will continue to shift the balance of hospitals participating on a mandatory or voluntary basis.

Whether mandatory or voluntary, bundled payment goals necessitate a strategy for activating patients. With it, you’ll already be on the path to healthier, more empowered patients when CMS or other payers come knocking.

What to know about CJR bundled payment program 

Topics: patient activation, Episode of Care, Comprehensive Care for Joint Replacement, Value-Based Care, Healthcare Technology