Oct17 | Signature Care Management

6 Fundamental Components for Bundled Payment Success

In January, Ann Conrath and Andrew Tessier from Signature Care Management were keynote speakers at the 2018 FOS & BSOF Coding & Reimbursement Conference in Lake Buena Vista, Florida. They shared the lessons we have learned as leaders in the Bundled Payment for Care Improvement (BPCI) initiative and the essential factors for success. The following highlights the key points from their presentation.

Fundamental Components for Success

  1. Physician Engagement – The success of the BPCI initiative relies heavily on the engagement level of physicians. Physicians set the tone for an entire episode of care and motivate a care team to implement care redesign strategies. A physician champion at the practice can help keep his or her peers engaged throughout the program.


  1. Hospital Partnership – Greater success is achieved when protocols and goals are aligned between hospitals and BPCI participants. Communication channels with BPCI case managers are established through meetings with local hospital administrators, discharge planners, and orthopedic floor nurses and ensure that a physician’s protocols are more likely to be followed. It is important to establish additional protocols with hospital partners as well:
    • Standardized patient education for the physician’s patients
    • Continuous engagement with acute care discharge planners
    • Accurate clinical documentation (chronic and co-morbid conditions, complications) to support appropriate coding of the billable procedure
    • Defined care pathways to ensure alignment between physician, hospital staff, BPCI case manager, and downstream partners


  1. Case Manager – Hiring the right BPCI case manager is of utmost importance. The case manager must possess leadership qualities, strong nursing skills, and a case management background. The ability to effectively communicate with physicians and mid-levels regarding patient status and care planning is essential to manage 90-day episodes of care.


  1. BPCI Committee – Establishing an internal BPCI committee to meet monthly and eventually quarterly to review processes, protocols, data, etc. is vital in order to make strategic decisions and continue progressing in a bundled payment program.


  1. Post-Acute Care Network. Development of a preferred provider post-acute care network aligns BPCI providers with post-acute care providers that are willing to adhere to physician-directed BPCI protocols and patient care plans. BPCI providers share best practices, care plan goals, and analytic reports to drive coordination with post-acute care facilities. A clear line of communication with providers ensures alignment of goals. Despite best efforts, some patients will need a brief stay at a skilled nursing facility (SNF) and maintaining good communication with the facility is crucial during the patient’s stay. Patients ultimately choose the facility they wish to use, but many patients will prefer to use a facility that comes recommended by their physician in order to facilitate smooth transitions from hospital to SNF to home.


  1. Data Analytics – To put it simply, what gets measured gets managed. Data needs to be specific, easy to understand, and lead to action items. Data analytics drive strategic program growth and is critical at all levels of the program from administrators to physicians, to case managers. It can counter the common refrain that “I have the sickest patients,” or “I don’t send any of my hips to SNF” and instead shows the real areas for growth and opportunity. Data analytics is critical for optimal performance. Physicians and clinical staff need to be engaged with frequent review of the data to address any concerns early.

Value-based care initiatives such as BPCI are pushing providers to redesign care strategies. While the process of transitioning to value-based care can be challenging, focusing on the key components streamlines process and can lead to great success..