Abeer Yassine

Abeer is the MVC Engagement Associate

Recent discussions and news regarding Alternative Payment Models (APMs) have had administrators and clinicians wondering the extent to which a bundled payment can be valuable in various healthcare settings.

According to an article by Modern Healthcare, health systems have seen variability in success with bundled payment models in which different conditions yield different outcomes. More specifically, chronic conditions such as congestive heart failure (CHF) may yield different outcomes in an APM than acute and surgical conditions. It is plausible that chronic conditions such as CHF may have more variability in achievement and outcomes due to external factors such as socioeconomic status, which impacts patient behaviors and outcomes. While addressing these factors can be a key piece to answering the variability, health systems and clinicians may not be equipped with resources to manage them which then impacts outcomes for CHF patients. However, this article notes that success in a heart failure bundled payment model may still be possible through increased focus on planning and enhancing post-discharge care. As bundled payment models are optimized, hospitals are rapidly working on identifying ways to make these models best work for them.

One hospital, Southwest General Health Center, in Ohio launched a patient follow-up program in 2015 to optimize their heart failure bundled payments. Clinicians focused on post-discharge care and ultimately reducing readmissions by enhancing communication efforts with patients through a variety of mediums such as telehealth monitoring and outpatient clinic visits. Since 2015, the hospital has seen a 20% reduction in 90-day readmission rate for CHF patients, improved patient-satisfaction scores, and about $800,000 payment savings from CMS.

As discussions regarding APMs and innovative models of care continue, it is crucial for hospitals to better understand the implications of such models on quality of care, patient outcomes, and costs. Next week’s blog will feature Mike Thompson, MVC’s Director of Analytics, diving deeper into the Bundled Payments for Care Improvement- Advanced model (BPCI- A), a new voluntary APM that was recently introduced by CMS.

If you have any questions, please do not hesitate to contact the MVC Coordinating Center, Deb Evans (debevans@med.umich.edu) or Abeer Yassine (abeery@med.umich.edu)  or directly comment on this article. We welcome your comments and feedback.