CMS has been experimenting with Medicare bundled payment arrangements, where the provider is reimbursed a total fee (either prospectively or reconciled retrospectively), for three decades. Under ACA authority CMS' Center for Medicare and Medicaid Innovation (CMMI) has launched several five-year bundled payment demonstrations, most notably BPCI that began in 2013. The BPCI demo allows providers to voluntary accept a bundled payment for any one of 48 Diagnosis Related Groups (DRGs), for example a heart attack, under three care models. Model Two is the most popular. It begins with an anchor acute hospital stay followed by 30 to 90 days of post acute care. The most common Model Two bundle is for hip or knee replacement surgery. Recently, the Lewin Group completed its third evaluation of the BPCI. Regardless of the demonstration's performance to date, has it moreover reduced spending and/or improved care quality and outcomes, it is anticipated CMS will renew the BPCI demo in the very near future since the current demo times out this September.
During this 25-minute discussion Mr. Clay Richards discusses naviHealth's BPCI's efforts, the company's BPCI financial and quality results to date, Lewin Group's most recent BPCI evaluation and how the demonstration can be improved under a reauthorized BPCI demonstration.
Mr. Clay Richards is CEO of naviHealth, a post-actue care transition company and one of the nation's largest BPCI convenors. The company, founded in 2012, partners with approximately 50 hospitals in 25 states, collectively they account for over 40,000 BPCI care episodes annually. Prior to joining naviHealth, Mr. Richards served as Senior Vice President of Healthways, Inc. Mr. Richards' community service includes serving on the Martha O'Bryan Center Board, the Oak Hill School Board and on the Vanderbilt Owen Graduate School of Management Board of Visitors. Mr. Richards was graduated from Washington and Lee University and from the University of Mississippi School of Law.
Information on naviHealth is at: https://www.navihealth.com/.
Information on the BPCI demo and the Lewin Group's evaluation can be found at: https://innovation.cms.gov/initiatives/bundled-payments/.