BPCI-Advanced Data Analytics and Program Support
In late 2022, the CMMI announced a strategy to better integrate specialist physicians into value-based care models. One element of the strategy is extending its BPCI-Advanced bundled payment model through 2025 and creating more flexibility for ACOs to participate in the model as a convener for multiple provider entities. The Institute has deep expertise in bundled payment models, and it has used the 100% Medicare claims data file to replicate the BPCI-A target pricing model. This allows us to measure risk-standardized bundled payment spending for ACO providers and generate benchmarking comparisons for hospital and specialty groups in every ACO’s geographic markets. We also offer data support for organizations considering joining BPCI-A and ongoing data and policy support for BPCI participants. See more details here.
Episode Analytics for Hospital and Specialist Care
We produce detailed episode of care reports to help ACOs identify opportunities to streamline care, reduce complications and identify efficient specialty practices within specific clinical domains. We use the PACES episode grouper – a sophisticated software tool designed specifically to address the complexity of Medicare beneficiaries – developed under a five-year contract with CMS. PACES incorporates chronic condition episodes, acute medical episodes and procedural episodes that we use to profile resource use at the patient, provider, population, and health system level.
Data Support for MSSP Benchmark Modeling
We develop the data you need to estimate future MSSP benchmarks whether you are an existing ACO or launching a new ACO. We run attribution for your ACO providers for all historical benchmark years and calculate PMPY spending and risk scores by beneficiary eligibility category. We also calculate regional PMPY expenditures, risk scores and trend rates. We work closely with your actuaries to support benchmark forecasting to help your ACO make informed strategic decisions.
Physician Group Performance Analysis
We build profiles of risk-adjusted spending, utilization and referral patterns of physician practices in your markets. These profiles help you develop performance benchmarks, assess changes in market share and identify groups that your ACO or clinically integrated network could potentially recruit based on their contribution to beneficiary attribution, cost efficiency and clinical quality.
Evaluation of Clinical Management Initiatives
Many groups utilize pre-post analysis to evaluate the impact of care management programs which can be heavily biased by natural changes in health status that occur over time (i.e., regression to the mean). We conduct scientifically rigorous evaluations based on clinically and geographically matched comparison groups that generate statistically valid results that measure the true impact of your programs on spending and utilization.
Post-Acute Care Network Performance
We profile the performance of skilled nursing facilities (SNF) in your market to support development of preferred relationships with high-quality efficient facilities. We analyze performance based on all of the SNF’s Medicare patients (not just your ACO patients) to provide reliable estimates of spending and quality. We also use MDS/OASIS assessments and can develop risk adjustment techniques that incorporate patient functional status.
QP Score Contribution by ACO Physician Groups
Congress recently froze the Quality Performance (QP) thresholds required for providers to receive the MACRA 5 percent advanced APM bonus. But, 20 – 30 percent of ACOs in downside risk models still may not qualify for the bonus. We offer a detailed analysis of QP scores for your ACO and physician groups and we conduct scenario analysis to support planning for your facilitate 2022 provider networks. Click here for a summary of our services.
Analysis of Attribution Dynamics
We can identify Medicare patients seen by your ACO’s primary care providers or specialists that are not attributed to your ACO and help you understand which providers are successfully competing for these patients and how. This information will help you develop strategies to increase the “stickiness” of patients to your ACO and grow your attribution.