CMS' efforts, via the Centers for Medicare and Medicaid Innovation (CMMI), to develop episode-based bundled payment models in Medicare is now it its eight year. This work is currently being pursued under the 2018-initiated Bundled Payments for Care Improvement (BPCI) Advanced (that succeeded the BPCI demo, begun in 2013, now concluded) and the Comprehensive Care for Joint Replacement (CJR) and the Oncology Care Model demonstrations, both began in 2016. These models are designed to pay a specified or target price for a discrete episode of care, in CJR for a hip or knee replacement. Assuming quality performance is met, if spending is below the target price the provider recoups the savings, if above the target they owe the difference. Recent evaluations, discussed here, show these programs are on balance demonstrating savings, though modest, to the Medicare program. Listeners may recall I interviewed Archway's Founder and CEO, Dave Terry two years ago this month.
During this 37 minute interview (lengthy but worth it), Ms. Macmillan begins by providing an overview of Archway Health. She then discusses Archway's results to date regarding participation in BPCI Advanced relative to financial performance, quality and utilization - that she unpacks by discussing what accounts for savings, what quality is being measured and how measuring quality can be improved and steps CMS is taking to more accurately target price episode payments via peer groupings. We discuss CMS' latest evaluation of the agency's CJR demonstration and other evaluation findings, participation by MA and commercial plans in episode based bundled payment arrangements, how best these demonstrations or models can be evolved, i.e., how better episode and population-based models can be better integrated, the inclusion of Part D spending, whether bundled payments should be made mandatory and what explains Archway's success in participating in these payment models.
Ms. Keely Macmillan is currently Senior Vice President of Policy and Solutions management at Archway Health where she oversees all aspects of Archway’s involvement CMS' Bundled Payments for Care Improvement (BPCI) Advanced demonstration. She is an expert in alternative payment models including bundled payments and ACOs, value-based purchasing, and MACRA’s Quality Payment Program. Previously, Ms. Macmillan was manager of government payment policy at Partners HealthCare, the largest health system in Massachusetts, where she managed public payer financial forecasting and led the government payment policy team in the analysis of performance-based reimbursement models. Ms. Macmillan earned her master’s degree in Health Policy and Management from the Harvard T.H. Chan School of Public Health and a Bachelor of Science from Yale University.
Information on Archway Health is at: https://www.archwayhealth.com/.
Mentioned during this discussion:
CMS' January 2020 8-page overview of episode based bundled payment results to date is at: https://innovation.cms.gov/Files/reports/episode-payment-models-wp.pdf.
The Lewin Group's second CJR evaluation published last June is at: https://innovation.cms.gov/Files/reports/cjr-secondannrpt.pdf.
Evaluations of BPCI published in the January issue of Health Affairs are by Amol Navathe, et al. and Rajender Agarwal, et al., are at: https://www.healthaffairs.org/toc/hlthaff/39/1 (subscription is required).