Bundled Initiatives Moving Forward With or Without CMS

When The Centers for Medicare & Medicaid Services (CMS) the expansion of mandatory bundled payment initiatives was delayed, the decision called into the question the pace of the health care system’s shift toward value-based care.

Under the Trump administration, new regulations are broadly being delayed, and some health care requirements are likely to come under the chopping block. Recent challenges to repeal the Affordable Care Act (ACA) under the Republican controlled Congress have also contributed to the possibility health care changes could stall.

However, home health providers looking to participate in value-based initiatives such as bundled payments can still bet on their long-term payoff. Despite the slowdown on the push for mandated value-based care initiatives, the health system is still moving toward this integration, according to experts across the continuum of care—with or without CMS’ carrot and stick.


Early Innings

When it comes to implementation of value-based care, the health care system is still in the “early innings,” according to David Friend, managing director of The BDO Center for Healthcare Excellence and Innovation, the health care division of consulting and accounting firm BDO.

Many of the most recent drivers to value-based care have stemmed from the passage and implementation of ACA, which pushed for innovative pilot programs that focus on patient-centered care that rewards quality.


However, the shift away from fee-for-service is nothing new, and many of the payment models have been in the works for years, Friend said.

“It’s not a new concept,” he told Home Health Care News. “It’s slowly gaining traction because it just makes more sense. Increasingly, CMS has been pushing for VBP and bundling, and folks are following along. …Ultimately, that’s going to push the whole system to value-based care—it’s now the law, and the incentives are in place.”

While still in the early phases of mainstream adoption, health care is unlikely to turn its back on this progress.

“The transition of value-based care is here to stay,” Carolyn Magill, CEO of software company Remedy Partners, told HHCN. “There is broad recognition that outcome is consistent with how the rest of the economy works. You want to pay for results, for quality. Those general premises will continue. We think the momentum is already in place and there are enough mechanisms. Even if the ACA were repealed, the commitment to VBP will continue, and bundles are an element of that.”

Remedy Partners is the largest convener under Medicare’s Bundled Payment for Care Improvement (BPIC) program, reaching more than 70% of participants.

Already, home health has a stake in these models, with 2.5% of all bundled payments through Remedy being initiated in the home, according to Magill.

Voluntary Participation

While mandatory bundles are delayed, voluntary value-based care models are charging on and attracting participants across the health care continuum. Like Health and Human Services Secretary Tom Price, Magill believes the same value-based goals can be achieved through voluntary programs.

“The nuance about the delay is that is applies to mandatory programs,” Magill said. “Voluntary [programs] allow providers to understand and truly invest in facilitating the program an give access through infrastructure and support. All of that is possible within voluntary programs.”

Providers—home health and others—are still likely to come on board with value-based initiatives without being forced to. The health system will continue to shift away from fee-for-service, and the early adopters could find participating in new payment models lucrative.

“An opportunity to improve care and optimize results will drive participation,” Magill said.

Friend agrees that health care providers are eyeing more opportunities for higher payments by becoming involved with value-based initiatives voluntarily.

“If they do this, they will get paid more, and most people want to get paid more,” he said. “That’s what’s driving the behavior.”

Written by Amy Baxter

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