Balancing Multiple APMs Programs: BPCI Advanced, ACOs, and More

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By Aimeé Bailey, MHA, MSN, RN-BC 

The final enrollment window for Bundled Payments for Care Improvement (BPCI) Advanced is now open. Providers are thinking about how BPCI Advanced fits in the context of other alternative payment models (APMs), such as Medicare accountable care organizations (ACOs) and other bundled payment programs. 

For some providers, the question is less about whether they specifically want to join BPCI Advanced, and more about planning for the addition of another risk-based program to their organization’s profile. 

Why join multiple APMs? 

Although the Centers for Medicare & Medicaid Services (CMS) continues to push providers toward APMs, joining multiple APMs is not a requirement. It is a decision that each organization should make for itself based on its patient population, care goals, and financial needs. Providers may find themselves needing to join multiple risk programs to meet patient or payment threshold levels in order to stay on the Advanced APM track in the Quality Payment Program and avoid having to follow Merit-Based Incentive Payments System (MIPS) reporting requirements. 

For providers that have reached this point in their value-based care journey, BPCI Advanced provides an opportunity to not only meet those thresholds, but also to earn savings as a reward for providing quality care at reduced cost. Bundled payment programs like BPCI Advanced have been proven to succeed in engaging specialists, making them particularly complementary to programs geared toward primary care, such as ACOs.

Tips for Managing Multiple APMs

When balancing multiple APMs, there are a few high-level keys to success. 

1. Put quality first
All APMs are primarily about improving care quality; the financial benefits are secondary. Implementing and ingraining a patient-centered care model frees clinicians to think less about programs and more about populations. In most APMs, there is usually an opportunity to start with low-hanging fruit such as post-acute utilization or investing in top-performing physicians. Then, providers can move on to addressing other quality drivers such as behavior, environment, and other social determinants of health. 

2. Simplify your programs  

Sometimes it’s OK to go one-size-fits-all. With multiple programs, many providers have found success approaching their programs with uniformity and simplicity. You can use overlap among the programs to your advantage. For example, many APMs have overlapping quality metrics. Providers can identify which metrics are most impactful to patients and approach care redesign with uniformity across the board. This allows you to zero in on specific improvements that have widespread impact. 

3. Use your data wisely
Strong analytics are paramount to the success of any APM. It can be advantageous to look at the data from multiple programs together. If you aggregate the data in a way that gives a full population view, you can see trends across different patient populations regardless of the program with which they are associated. 

4. Ensure clear education, communication, and engagement of stakeholders
When you take into account the Quadruple Aim, keeping providers happy in an atmosphere of change should also be a priority. Providers may perceive participation in multiple programs as a source of frustration because they see more rules, regulations, and documentation. Listening to the providers driving your care and not overwhelming them is crucial to keeping them on board.   

5. Don’t be afraid
No matter the program, the goals are the same – improve care quality and outcomes at lower costs. CMS has found in the last few years that APMs are particularly successful at helping providers meet those goals, and the agency is doubling down. New primary care APMs were released recently, and CMS will be announcing more new models this year, to begin in 2020. 

The need for providers to balance participation in multiple programs will only grow as CMS continues to encourage providers to adopt APMs. This is the way of healthcare, and providers should embrace it and feel empowered to take it on. 

About the Author

Aimeé Bailey is Senior Director of Care Operations at Archway Health, and an advocate of patient-centered care and has a diverse clinical background that spans acute, managed, and Accountable Care Organizations. At Archway, Bailey utilizes her nursing background to provide strategic and operational leadership to Archway’s programs. 

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