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Since day one Assure has taken a proactive and innovated approach to its patient-centered care delivery models, directing their efforts on developing their staff, programs, processes, and technology arm to support the every changing healthcare market. It was a natural progression to align their best practice with CMS pioneering, initiative. In April of 2015  Assure Home Healthcare, Inc., was selected as a Single Awardee Model 3 for the Bundled Payment Care Improvement Initiative (BPCI), through the Center for Medicare and Medicaid Innovation (CMMI). Assure is elated and proud to state based on our care redesign submission in Q2 2014; CMS chose AHHC as 1 of 2 Home Healthcare Agency in the state of Illinois to participate in CMS Bundled Payment Care Improvement Initiative.

Assure went live on July 1st, 2015 with the first beneficiary within the BPCI pilot study. In this 3-year pilot study, the overall goal is to improve quality care coordination while reducing unnecessary Medicare spending. To navigate through the BPCI pilot study with CMS, we have engaged a nationally recognized healthcare analytics partner of DHG Healthcare to arm Assure with real-time reporting analysis with a consultative approach to reducing 30day readmission rates among high complexity patients. We utilize our proven technology and analytics partner coupled with our clinical best practices to partner with hospitals, physicians, and post-acute care providers to improve outcomes for all of the selected 48 DRG’s.

“At Assure Home Healthcare we are committed to being transparent about our quality measures and dedicated to always working to improve how we deliver care. Sharing data and recognitions such as this one make us better by allowing our patients to make informed decisions and to be active participants in their healthcare outcomes. We are unwavering in providing clinical excellence and determined to continually raise the bar in home healthcare by setting new industry standards for quality care and personalized service. That is why patient’s and our partner’s every day look to Assure for their home health care needs, said Mr. Brandon Mahinay – CEO of Assure Home Healthcare”.


BUNDLED PAYMENTS 101 – FACTS SHEET

WHAT IS BUNDLING? 

Traditionally, Medicare makes separate payments to providers for each service they perform for beneficiaries during a single illness or course of treatment. This approach can result in fragmented care with minimal coordination across providers and health care settings. It also rewards the quantifier of services offered by providers rather than the quality of care furnished. Research has shown that bundled payments can align incentives for providers – hospitals, post-acute care providers, physicians, and other practitioners – allowing them to work closely together across all specialties and settings.

WHAT ENCOMPASSES CARE REDESIGN INITIATIVE?

The Bundled Payments for Care Improvement initiative is comprised of four broadly defined models of care, which link payments for multiple services beneficiaries receive during an episode of care. Model 1 focuses on the acute care inpatient hospitalization. Awardees agree to provide a standard discount to Medicare from the usual Part A hospital inpatient payments.  The first set of participants in Model 1 began in April 2013, and additional participants began in January 2014. Models 2 and 3 involve a retrospective bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care. Model 4 involves a prospective bundled payment arrangement, where a lump sum payment is made to a provider for the entire episode of care. The first set of participants in Models 2, 3, and 4 were announced in January 2013. Over the course of the three-year initiative, CMS is working with participating organizations to assess whether the models being tested result in improved patient care across all settings and lower costs to Medicare.

Plans for all models include care redesign and enhancements, such as reengineered care pathways using evidence-based medicine, standardized operating protocols, improved care transitions, and care coordination across the continuum of care. All may also include proposals for gainsharing among provider partners.

RETROSPECTIVE PAYMENT BUNDLING

Model 3: Retrospective Post-Acute Care Only:
For Model 3, the episode of care will be triggered by an acute care hospital stay and begins at the initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agency. The post-acute care services included in the episode must begin within 30 days of discharge from the inpatient stay and will end either 30, 60, or 90 days after the initiation of the episode. Participants can select up to 48 different clinical episodes.

In both Models 2 and 3, the bundle includes physicians’ services, care by post-acute providers, related readmissions, and other related Medicare Part B services included in the episode definition such as clinical laboratory services; durable medical equipment, prosthetics, orthotics and supplies; and Part B drugs. A target price is set based on historical fee-for-service payments for the participant’s Medicare beneficiaries in the episode including a discount. Payments are made at the usual fee-for-service payment rates, after which the aggregate Medicare payment for the episode to be reconciled against the target price. Any reduction in expenditures beyond the discount reflected in the target price will be paid to the participant and may be shared among their provider partners. Any expenditure that is above the target price will be repaid to Medicare by the participant.