Home health care providers participating in bundled payment models are seeing mixed results, according to one major company that revealed their first-year results last week at the National Leadership Conference co-hosted by the Visiting Nurse Associations of America (VNAA) and the Alliance for Home Health Quality and Innovation.
Despite a delay in mandatory bundled payment initiatives, these and similar alternative payment models are charging forward—CMS hopes to have a 50/50 mix of alternative and traditional fee-for-service payments by 2018.
With this in mind, health care providers are actively pursuing these opportunities.
“This is where I would put my chips on the table,” Mark Sharp, partner at home health consulting and accounting firm BKD, said during the National Leadership Conference.
In a bundled payment system, payments for health care services are linked within an episode of care, where providers enter payment arrangements with other organizations to coordinate care at a lower cost. Despite the move toward these models, the viability of these programs for home health care providers is still up in the air, as one major company found out after participating in hundreds of bundles last year.
Trinity Health, a national Catholic health system based in Livonia, Michigan, is participating in more than 300 bundles, with its home heath arm, Trinity Health at Home, taking part in three initiatives. Trinity Health at Home operates 12 home health agencies and six hospice programs with locations in Michigan, Indiana, Iowa, California, Maryland and Ohio.
Through its home health division, the company participates in Medicare Bundled Payments for Care Improvement (BPCI) models 2 and 3. Separately, Trinity took part in CMS’ Home Health Value-Based Purchasing in Maryland and Iowa.
In aggregate, Trinity Health at Home lost money on its bundles in 2016, according to Patrick Brown, vice president of finance for Trinity Health at Home.
“It wound up being negative,” Brown said of the 2016 results. As such, Trinity has to pay back CMS for some of its bundles that did not meet cost savings goals.
While the provider is on pace to see better results in 2017, the impact has led Trinity Health at Home to drop all model 3 bundles going forward. Specifically, the provider will drop its bundles in free-standing home health locations. It will remain in bundles where the home health location is based out of a Trinity Health hospital, Brown told Home Health Care News.
One of the biggest causes of the losses was a lack of physician engagement, Brown said during his presentation. Certain patients from a handful of physicians cost significantly more, outweighing other patients in a bundle by bumping up the overall cost.
While there is an opportunity to save money in bundles, Brown says that the number of patients can be a huge driver in the overall success. Collaborating with BPCI patient navigators can also improve engagement in the care process necessary for success in bundles.
Tools to Succeed
With its first year of bundles under its belt, Brown shared a few lessons the company learned along the way. Here are some of his recommended tools for home health care providers to succeed in bundled payments:
—A culture that focuses on visits per episode. Limiting the number of visits can drive down care costs, but providers have to balance this with quality of care, as well. A company needs to be aligned as it shifts from focusing on visits per episode to the overall cost of care.
In a sense, going into a bundle as a quality operator can “set us up for failure to achieve reductions” in the number of visits and overall costs, Brown said.
—Physician engagement. The biggest driver of losses for Trinity Health at Home came from a few physicians and a handful of patients. Without engagement on the physician side to keep patients healthy at home, one patient in a bundle with astronomical costs can bring down the whole model.
Managing the physicians in its remaining bundles has become the No. 1 focus for Trinity Health at Home in 2017, Brown told HHCN.
—Improve data metrics. Utilizing internal resources to review risk was challenging for Trinity, according to Brown. Improving data metrics to keep track of patients in real time, in conjunction with better communication and engagement with physicians, could improve overall bundle results, he said. Software systems must be able to track critical information and provide that to home health agencies in real time.
Written by Amy Baxter