Episode Payment Models: CJR Results and BPCI Advanced Opportunities

      
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Episode Payment Models: CJR Results and BPCI Advanced Opportunities 
 
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Overview
CMS recently released Comprehensive Care for Joint Replacement (CJR) model results for Performance Year 1 (episodes with start dates between April 1st and September 30, 2016 and end dates on or before December 31st, 2016.) The CJR model is a mandatory bundled payment model in which 799 participating hospitals from 67 metropolitan statistical areas (MSAs) were originally required to participate. Each episode begins with a lower extremity joint replacement procedure, and completes after 90 days post-discharge. There was no downside risk for Performance Year 1, but future years will include downside risk. Going forward, a recent CMS final rule will allow hospital participation in 33 of the 67 MSAs to become voluntary, which will result in fewer participating hospitals in the program.

Milliman has analyzed the Performance Year 1 results, examining hospital financial performance and quality performance metrics. They have calculated average reconciliation payment amounts per episode by quality performance categories, and addressed distribution of payment status by hospital size as well as applicable DRG (469 and 470) volume.

In addition to the implications of the CJR model results, introduction of a new significant episode payment model demands the attention of stakeholders going forward. CMS recently announced a new voluntary episode payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced) that will qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program established by MACRA. Initial participants will start October 1, 2018, with the Model Period Performance running through December 31, 2023. CMS will provide a second application opportunity in January 2020. Participants bear financial risk, have payments under the model tied to quality performance, and are required to use Certified Electronic Health Record Technology.

BPCI Advanced will initially test bundled payments for 32 Clinical Episodes (29 inpatient and 3 outpatient) but CMS may elect to revise the Clinical Episodes in BPCI Advanced on an annual basis beginning in 2020. Participants selected to participate in BPCI Advanced beginning on October 1, 2018, must commit to be held accountable for one or more Clinical Episodes and may not add or drop such Clinical Episodes until January 1, 2020. Deciding whether or not to apply to BPCI Advanced is a key question for many stakeholders, and decisions must be made quickly as applications are due March 12, 2018.

Please join us Wednesday, February 28, 2018 at 1 PM Eastern as Milliman's Pamela Pelizzari discusses CJR performance year one results and insights, requirements, challenges and opportunities regarding the newly announced BPCI Advanced Program, in the HealthcareWebSummit event: Episode Payment Models: CJR Results and BPCI Advanced Opportunities.
Learning Objectives

After attending this webinar, attendees will be able to:

  1. Examine CMS CJR Bundled Payment Model Performance Year 1 results.
  2. Ascertain Milliman analysis of CJR results regarding financial and quality performance metrics and distribution of payment status by hospital size as well as applicable DRG.
  3. Consider implications of CJR results, CMS final rule changes and introduction of downside risk going forward.
  4. Understand the components and requirements of the new BPCI Advanced program.
  5. Explore the implications, challenges and opportunities presented by the BPCI Advanced program.
  6. Engage in interactive learning through online question submission, attendee feedback and opportunity for follow up questions, and networking with attendees, faculty and other professionals through dedicated LinkedIn group.
Who Should Attend

Interested attendees would include:

  • C-Suite Executives
  • Value Based Payment Executives and Staff
  • Provider Network Operations Executives and Staff
  • Analytics Executives and Staff
  • Actuarial Executives and Staff
  • Finance Executives and Staff
  • Managed Care Executives and Staff
  • Revenue Cycle Executives and Staff
  • Planning and Strategic Executives and Staff
  • Business Intelligence Staff
  • Regulatory and Compliance Executives
  • Other Interested Parties

Attendees would represent organizations including:

  • Hospital and Health Systems
  • Provider Networks
  • Medical Groups
  • Other Providers
  • Health Plans
  • Government
  • Life Science Organizations
  • Solutions Providers
  • Associations, Institutes and Research Organizations
  • Media
  • Other Interested Organizations
Registration
  Individual Registration Fee: $195. Post-event materials, with video of slides synchronized with speaker audio, plus presentation pdf file: $45 for attendees; $260 for non-attendees after the event. Register online or download the event flyer.
 
 
 
Register Now   Click here to register or call 209.577.4888. Corporate Site licensing also available. We look forward to your attendance!
 
 
Faculty
 
Pamela M. Pelizzari

Pamela M. Pelizzari,
MPH, Senior Healthcare Consultant
Milliman, Inc.

 

Pamela is a senior healthcare consultant with the New York office of Milliman. She joined the firm in 2014. Pamela has a broad background in integrated delivery system administration and healthcare payment reform. She has worked in both clinical and payer settings and has extensive experience in alternative risk contracting strategies. Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies.

Prior to joining Milliman, Pamela held a technical advisory role in the U.S. federal government. She was responsible for developing and implementing novel payment methodologies to transform healthcare delivery and payment nationwide. Previously, Pamela also worked in quality improvement at an academic medical center.

Pamela has an ScB in Applied Mathematics and an AB, Community Health from Brown University, and a MPH from Johns Hopkins Bloomberg School of Public Health.

  
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