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Bundled Payments for Care Improvement:Application Consideration for Models 2-4                  Patient Care Models Group ...
Presenters•   Jeffrey Clough, MD, MBA, Patient Care Models Group•   Amy Harbaugh, MBA , Patient Care Models Group•   Pamel...
Thank you Thank you for your continued engagement   in this initiative. We have received anenthusiastic response from prov...
Agenda• Timeline• Episode convergence• Questions                        4
Timeline for Application Consideration• Late September, 2012: External expert review panels  review and provide recommenda...
Timeline for Application Consideration• Next steps commence: Recommended awardee vetting  and clearance of model plan by f...
Episode Convergence• Diversity of proposed episodes• Operational need for convergence• Informed by applications submitted ...
Episode Convergence• Anchor Clinical Conditions• Part A and Part B Exclusions• Episode Length                             ...
Episode Convergence• Methodology for determining the target price and  performing payment reconciliation   – Addressing ou...
Episode Convergence• Beneficiary exclusion• Proration methodology                          10
Episode Convergence• Discount Percentage• Waivers                        11
Further specific questions and issues  identified by candidate awardeesWe will address these following the early Octoberco...
Questions?At this time, we will accept questions via the chat               feature on your screen.For further questions, ...
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Webinar: Bundled Payments for Care Improvement - Models 2, 3, and 4 Application Considerations and Next Steps

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The Bundled Payments for Care Improvement team held a webinar to update applicants on the application consideration process and the next steps they can anticipate. All Model 2, 3, and 4 applicants as well as provider partners were invited to attend.

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Transcript of "Webinar: Bundled Payments for Care Improvement - Models 2, 3, and 4 Application Considerations and Next Steps"

  1. 1. Bundled Payments for Care Improvement:Application Consideration for Models 2-4 Patient Care Models Group Innovation Center Centers for Medicare & Medicaid Services September 12th, 2012
  2. 2. Presenters• Jeffrey Clough, MD, MBA, Patient Care Models Group• Amy Harbaugh, MBA , Patient Care Models Group• Pamela M. Pelizzari, MPH, Patient Care Models Group• Elizabeth Truong, MHS, Patient Care Models Group 2
  3. 3. Thank you Thank you for your continued engagement in this initiative. We have received anenthusiastic response from providers acrossthe country, and we look forward to working with you in the coming months. 3
  4. 4. Agenda• Timeline• Episode convergence• Questions 4
  5. 5. Timeline for Application Consideration• Late September, 2012: External expert review panels review and provide recommendations to CMS on each application• Early October, 2012: CMMI staff initiates group and individual discussions with candidate awardees (derived from panel recommendations combined with CMS program judgment)• Late October, 2012: CMMI staff engages in work to address questions and issues raised by candidate awardees 5
  6. 6. Timeline for Application Consideration• Next steps commence: Recommended awardee vetting and clearance of model plan by federal agencies• Model 2,3, and 4 agreements shared and discussed with recommended awardees• Agreements signed; implementation begins 6
  7. 7. Episode Convergence• Diversity of proposed episodes• Operational need for convergence• Informed by applications submitted and CMS program policy objectives• Topics will be discussed in various formats during candidate interviews and throughout the process• CMMI plans for significant engagement with candidates in the coming months 7
  8. 8. Episode Convergence• Anchor Clinical Conditions• Part A and Part B Exclusions• Episode Length 8
  9. 9. Episode Convergence• Methodology for determining the target price and performing payment reconciliation – Addressing outlier cases – Approach to MS-DRGs with small numbers of episodes – Trending target prices into performance years• Risk-adjustment 9
  10. 10. Episode Convergence• Beneficiary exclusion• Proration methodology 10
  11. 11. Episode Convergence• Discount Percentage• Waivers 11
  12. 12. Further specific questions and issues identified by candidate awardeesWe will address these following the early Octobercommunication with candidate awardees (applicants who reach the next stage of consideration). We look forward to hearing from you. 12
  13. 13. Questions?At this time, we will accept questions via the chat feature on your screen.For further questions, please email BundledPayments@cms.hhs.gov 13
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