Crucial connections

The shift from volume to value in health care reimbursements is well underway. Pure fee-for-service now accounts for just 37 percent of payments, according to the Change Healthcare-sponsored State of Value-Based Care in 2018 survey of payers. By 2021, just a quarter of reimbursements are expected to be volume-based. In their place are growing alternative payment models like Accountable Care Organizations and bundled payment arrangements — such as the new Bundled Payment Care Initiative Advanced from the Centers for Medicare and Medicaid Services — that hold hospitals and health systems accountable for the quality and cost of care after patients leave the hospital.

BPCI Advanced kicked in on Oct. 1 and reimburses providers (whose participation is voluntary) for up to 32 clinical episodes based on a 90-day episode of care that includes post-acute services. If providers spend less than the target price, they are paid a bonus. If they spend more than the target — thanks to the patient being readmitted due to complications, for instance — they are assessed a penalty.