In June, the Centers for Medicare and Medicaid Services released the Bundled Payments for Care Improvement (BPCI) Advanced reconciliation statement for Performance Period 2 (PP2), covering episodes of care initiated between early April and late September 2019. Today, Archway Health, a full-service, tech-enabled partner to healthcare organizations in risk-based payment programs, announced that the company’s performance projections were within 1% of CMS’ reconciliation statements and resulted in Archway’s provider partners achieving positive financial results from this latest performance period. During PP2, Archway’s provider partners generated more than $1,600, or 9%, per episode, in Medicare savings, and returned 3% in savings to the Medicare trust fund.
“We are proud to see our provider partners continue to perform well in this second performance period of the BPCI-A program. Additionally, the level of accuracy and predictability we were able to provide our clients in PP2 is powerful because it gave them the ability to act with foresight as they planned the success of their organizations, something that is increasingly critical for healthcare providers as they face financial challenges associated with shouldering increased risk in these types of programs as well as uncertainty associated with the COVID-19 pandemic,” said David Terry, CEO of Archway Health. “These results are an extraordinary endorsement of the hard work and collaboration between our clinical, accounts management and analytics teams, alongside our provider partners, and validates our data-driven approach to helping providers succeed in bundled payment programs and deliver better patient care.”
Archway analyzed the performance results and identified a number of key factors that contributed to the improved forecasting, including:
● Leveraging monthly claims data to replicate the Patient Case Mix Adjustment algorithm, allowing provider partners to monitor Target Prices based on the actual acuity of patients in the performance period.
● Developing a methodology to more accurately predict the ratio of real to standardized dollars and mitigate some of the uncertainty that comes with payment policy adjustments and swings in utilization.
● Utilizing all of the data from Performance Period 1 along with the latest monthly claims information to estimate where and when spending may occur throughout an episode of care.
● Exercising the 30-day window to confirm the accuracy of the CMS reconciliation spreadsheet against the raw claims, looking for volume, price and cost, winsorization, and extra, or missing claims.
● Taking into account CMS’s improvements in flagging monthly data for multiple attribution associated with a particular episode of care.
Read our blog post, “Exploring Key Drivers of Performance Accuracy in BPCI-A Performance Period 2” to learn more about the key drivers that contributed to Archway’s accuracy.
About Archway Health
Archway Health, founded in 2014 and built on a deep foundation of healthcare payment reform expertise, works with providers and employers to design and execute care and risk management initiatives that improve care and reduce costs. Archway works with leading healthcare providers participating in risk-based contracts including CMMI bundled payment programs such as BPCI Advanced, OCM, and CJR. Additionally, Archway works with Medicare and commercial ACOs, self-insured employers, and commercial payers. To support these programs, Archway collaborates with organizations to analyze their opportunities and risks, and deploys a comprehensive platform of analytics, patient tracking tools, Value-Based Risk Protection stop-loss programs, and advisory services. For more information, please visit www.archwayhealth.com.
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