Bundled Payments for Care Improvement Advanced

The Bundled Payments for Care Improvement Advanced (BPCI Advanced) model, also referred to as bundles, is a two-sided, value-based incentive program managed by CMS. Baptist Health has participated in this model since 2020 as it rewards efficient, high-quality care and supports enhanced care coordination. Under the BPCI Advanced model, Baptist Health is responsible for the total cost of care for patients in certain defined episodes. Savings are generated if the total cost for an episode is less than the benchmark cost for the episode; losses are generated if total costs exceed the benchmark episode cost. Savings and losses are adjusted based on quality scores. BPP manages quality and costs for patients in the BPCI Advanced model.

A BPCI Advanced clinical episode is triggered either at the start of an inpatient admission (Anchor Stay) to an acute care hospital or at the start of an outpatient procedure (Anchor Procedure). Inpatient admissions that qualify as an anchor stay are identified by Medicare Severity-Diagnosis Related Group (MS-DRGs) codes, while outpatient procedures that qualify as an Anchor Procedure are identified by Healthcare Common Procedure Coding System (HCPCS) codes. These codes are rolled up into eight different clinical episode service line groups (CESLGs) that model participants elect to partake in. The Clinical Episode length is the Anchor Stay plus 90 days following the day of discharge, or the Anchor Procedure plus 90 days following the day of completion of the outpatient procedure. Clinical episodes include all services that overlap the Clinical Episode window, with some exclusions.

Baptist Health participates in this program at the hospital level. Baptist Jacksonville, Baptist South and Baptist Clay all participate in eight CESLGs as one entity under the Baptist Jacksonville CMS Certification Number (CCN). Baptist Beaches participates in five CESLGs.

BPP utilizes the Committee to Operationalize Medicare Value-Based Programs (COMVP) to engage specialist physicians under bundles. COMVP focuses on reducing 90-day hospital readmissions, decreasing SNF utilization, and optimizing care for patients who are at end of life. This committee also serves as a platform for feedback on home-based programs to further prevent avoidable acute and post-acute utilization.

Care Coordination Strategy: CarePort CarePort Connect, a care coordination solution that connects Baptist Health hospitals to SNFs, went live in November 2022, replacing Signify Health’s Episode Connect. This solution displays real-time data on patient transitions and allows for effective care coordination decisions. It provides timely information on where patients currently are and their clinical status after they are discharged from the hospital. This solution is integrated with more than 95% of

SNF electronic health records. This fosters a timely, collaborative relationship with them to optimize utilization. CarePort Connect is a critical solution in our overall BPCI Advanced strategy.

The Baptist Physician Partners ACO achieved its third consecutive year of top-ranking results in both clinical performance and health care savings for Northeast Florida’s Medicare population. With a strong focus on quality through the Medicare Shared Savings Program (MSSP), the ACO lowered the expected cost of care by nearly $34 million for more than 40,000 Medicare beneficiaries in 2021. Over the last four years, BPP has improved health outcomes and reduced health care spending by more than $75 million. The overarching goal of the ACO is to deliver high-quality, appropriate care across all settings at the lowest possible cost.

These accomplishments of the ACO under MSSP serve as a milestone for value-based care; however, improvements to our overall quality score, specifically patient experience, are a focus for 2023 and beyond. Additional opportunities include addressing prescription medication discussions and cost, result follow-ups, fall risk assessments, depression screenings and follow-ups, and tobacco screening and cessation intervention.

Clinical success is attributed to physician collaboration across the ACO, care coordinator support for high-risk patients, reducing unnecessary hospital admissions and readmissions, and implementing enhanced

MSSP Final Performance Feedback

home support models that allow patients to recover at home. From 2020-2022, the care coordination team coordinated care for nearly 9,000 Medicare beneficiaries annually. BPP continues to participate in Premier’s Population Health Management Collaborative (PHMC), which coordinates a group of ACOs to share knowledge, data and expertise on program performance. The PHMC includes 66 ACOs across 34 states. Through these efforts, BPP achieved the following results compared to the average of ACOs in the Premier PHMC in 2021:

• Hospitalizations were 16.5% lower

• Prevented nine fewer admissions per 1,000 Medicare beneficiaries

• Transitioned 11 fewer Medicare beneficiaries per 1,000 to skilled nursing facilities. Among beneficiaries who transitioned to a SNF, their average length of stay was four days shorter.

BPP intends to participate in MSSP for the foreseeable future.

MSSP Membership