11/29/2018

90-Day Episodes of Care and the New Patient Communication Framework

Josh Schlaich, MA, MHA, Director of Product Marketing

As the financial responsibility of providers continues to expand beyond the care provided in a hospital or clinic, value-based care initiatives are offering incentives to providers to redesign care strategies. The Centers for Medicare and Medicaid Services (CMS) has a new and popular advanced alternative payment model—Bundled Payment for Care Improvement Advanced (BPCI Advanced). It features a standard length of 90 days for all episodes. That means what happens during those 90 days after discharge could significantly affect margins providers retain after reimbursement. In short, it’s a lot more risk for providers to take one standard payment that is set prospectively.

 

The potential for a significant amount of value is high if provider organizations can lower costs and generate healthier patients at discharge. The structure of the BPCI Advanced model is another forward step toward assuming and sharing risk, while still allowing provider organizations to pursue volume.

To demonstrate how much bundled payments have changed since the inception of the first CMS-sponsored payment model, here are a few fast facts.

BPCI Model Episode Length Eligible Initiators Prices Set Years Active
1 Inpatient stay only Acute care hospitals Retrospectively 2013–2016
2 30, 60, or 90 days Acute care hospital, post-acute care providers Retrospectively 2013–2018
3 30, 60, or 90 days Post-acute care providers Retrospectively 2013–2018
4 30 days Acute care hospitals Prospectively 2013–2018
Advanced 90 days Acute care hospitals, physician group practices Prospectively, reconciled retrospectively 2018–2023

Must-have: Meaningful and consistent communication with patients

With the increasing length of responsibility for patient outcomes and continued pressure to take on additional risk with each phase of the bundled payment program, providers are looking for more ways to engage patients at all points of the extended care continuum. One frequently overlooked way to control per-episode costs is meaningful and consistent communication with patients, families, and caregivers. Regardless of the reason for an episode of care, clinician-patient communication is integral to maintaining the financial viability of value-based care models such as BPCI Advanced. Studies show that people who are engaged in their health have better outcomes.

There are countless factors to consider when assessing patient-clinician communication over the course of a 90-day episode. This makes it important to first provide a logical and focused framework through which to evaluate specific service lines, episodes of care, types of patients, or procedures.

Best practice: Communication mapping

You can design a system or create a tool that fits your needs. Consider how each phase during the care episode benefits from the right education, in the right way, at the right time. Here’s an example of an orthopedic episode of care in a logical framework to help you get started with communication mapping.

Orthopedic Episode Communication Map

Phase of Care Communication Factors
  Timing Place Channel Message
Pre-surgical
  • 10 days prior: phone call
  • 7 days prior: direct mail
  • 5 days prior: email
  • 2 days prior: phone call
  • Virtual: phone call, email, direct mail
  • In-person: classroom session
  • Phone call from central scheduling
  • Portal-generated email
  • Direct mail from marketing
  • Classroom instruction
  • When to stop any medicines; when to stop food and water intake
  • Check-in process, including parking and early arrival
  • What to expect during stay and recovery
Inpatient stay
  • Admission day
  • Inpatient day(s), if applicable
  • In-person: may involve family and caregivers
  • Face-to-face: bedside tablet
  • Fall education: understand safety precautions
  • Medication and treatment plans: know approach to pain management
  • Therapy expectations: physical and occupational therapy goals for best length of stay
Discharge
  • Day 2 after admission
  • In-person: may involve family and caregivers
  • Face-to-face: bedside tablet
  • Written and printed instructions
  • Medication education
  • Transition knowledge
Post-acute
  • Prescheduled intervals for follow-up after discharge
  • Virtual: phone call, email, patient portal
  • In-person: follow-up appointments, outpatient rehabilitation
  • Face-to-face
  • Phone call
  • Portal-generated email
  • Rehabilitation goal-setting, transitioning to self-care
Care management
  • Regular intervals post discharge: typically at 15, 30, 60, and 70 days
  • Virtual: phone call, email, patient portal
  • In-person: wellness checks, screening appointments
  • Face-to-face
  • Phone call
  • Portal-generated email
  • Self-care, ongoing treatment and prevention, long-term health goal-setting

Every phase includes unique opportunities for meaningful and effective communication about a patient’s care and to restate and reinforce information about his or her condition, treatment, tests, and care plan. When you educate patients at each of these communication points, they are more likely to remember what you’ve taught them. They’re also better prepared to:

  • Stick to medication plans.
  • Stay involved in care plans.
  • Know when to call clinical staff, and when not to call.
  • Recognize any potentially serious health problems.

As your organization participates in bundled payment episodes of care, consider ways you can enhance your communication and education practices to keep patients more engaged in their care, and ways you can control costs throughout the care episode. Build out your framework for communication touchpoints and opportunities for growth in each bundled payment episode type.

Learn more about this in our eBrief, Succeed With BPCI Advanced—Keep Patients Engaged With Education Across the Care Episode.

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