Sun. Nov 29th, 2020

The clinical, operational and financial implications of this model will be important for most of the initial 800 hospitals. Even if your organization is not part of this first wave of providers, this decision should not be dismissed lightly. CMS decides to go ahead with CJR Mandatory Bundles InitiativePrior to the completion of Bunded Pay for Care Reform Initiative, this indicates that episodic bundling as a major lever in its transition to value-based care, and is likely to affect nearly all US hospitals in the near future .

Under pressure to meet the upcoming April 1 deadline, many organizations have run the risk of focusing only on the proximate needs of the CJR extended episode – addressing it as an individual project, other value-based and clinical Performance improvement is separated from initiatives. As the need to address additional episodes of care and patient areas over time, a different approach would tax the organization and could jeopardize overall outcomes. Instead, we recommend directly addressing the CJR bundle, combining its efforts with the development of broader organizational capabilities that will support a comprehensive and scalable program in the long term.

The benefits of programmatic approach are wide reaching, including:

  • Ensures a comprehensive view of the initiative across the organization, allowing for the prioritization of resources
  • Allows for a unified voice from leadership on the importance of each effort and how each fits into a broader vision for value-based care
  • Facilitates a consistent approach to physician engagement
  • Creates economies of scale and expertise

Even though April 1 is fast approaching, there is still time to address the need keeping the big picture in perspective. The CMS rule has no repayment requirements in year one and limited risk in year two. This gives participants the time required to design and execute a more effective, sustainable and scalable solution. For providers outside the scope of the CJR, the focus should now be on the active development of programmatic competencies to prepare for future value-based activities.
By taking a structured, purposeful approach, organizations can use CJR to form the foundation of a large-scale program. Below are six recommendations to get you started:

Recommendation

Near term requirements

Long term capabilities

Activate organizational leadership

Bring together clinical and administrative leaders from across the organization To collaborate on the development of the necessary clinical, operational and financial capabilities.

  • Leadership alignment
  • Organizational accountability

Understand your drivers of population and performance

Examine differences in financial, quality, and service performance among patient peers (eg, medical risk, elective vs. incidental and knee vs. hip) to inform performance improvement work. As new care processes and protocols are designed, incorporate real-time feedback mechanisms to monitor adherence and quickly identify drivers of performance when they slip.

  • Quality, satisfaction and usage reporting
  • Claims data management
  • Performance management and data sharing

Engage your doctors

Broaden the type of practitioners involved in improvement efforts beyond the specialist. Engage and align hospital and primary care physicians to address the fungal costs embedded in the process that remain outside the process.

Advance your care model

Use the development of new care pathways and protocols for a specific episodic bundle, such as CJR, as an opportunity to build competencies for a coherent approach that can be applied to other, similar efforts. this Adaptation of care procedures is required for this population to manage common medical complications and reduce their risk before surgery. At the same time, find solutions to aggressively manage the variance of costs under your direct control.

  • Clinical Protocol and Care Pathway Development
  • Care Management and Discharge Planning
  • Patient engagement
  • Cost and quality variance management

Engage your community partners

Assemble a high-performing post-provider provider network, understand cost differences between providers and develop relationships to collaborate with these organizations in clinical protocol and care path redesign efforts.

  • Post-rapid provider network development and management
  • Independent provider support

Align economic incentives

To develop an economic incentive distribution model to ensure the investment of all accountable parties for the success of the program. The resulting model should be simple to understand and defer to, incorporate a quality-gating functionality and be developed with the understanding that the now preceding set will affect future programs.

  • Internal money flow development
  • Physician gainings

Tom Graff is the national director of population health, Melissa McCain is the director of clinical change and Stephanie Hines is the clinical change practice manager at The Chartis Group.

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