Here are our top five recommendations for driving meaningful provider alignment under CJR:
1. Start with your Data: Carefully analyze your historical CMS claims data and identify post-acute care utilization both historically over time in your facility and versus your region. Assess individual physician utilization as well as which post-acute providers are receiving the majority of your referrals. Research best practice across the country for post-acute utilization and quality to drive goals for improvement and set standards for ideal physician and post-acute provider partners. Most importantly, project and get comfortable with your financial opportunity and/or hurdle based on your data analysis and use that knowledge to drive decisions related to alignment.
2. Assess your Alignment Landscape: Decide who it makes sense to have a collaborator agreement with. Decide what defines a good partner in CJR. Do you have physicians that are unlikely to make necessary changes without the opportunity to gainshare? Should you gainshare with other post-acute providers or suppliers?
3. Define Quality Improvement Priorities: Determine the quality criteria for those that are allowed to have collaborator agreements with your hospital as well as the quality metrics that will drive performance for gainsharing.
4. Leverage Alignment to Drive Comprehensive Care Redesign: Examine operations, clinical standards and where or why decisions for care are made during anchor hospitalizations. Collaborate with physicians to redesign acute care to encourage optimal clinical outcomes, high patient satisfaction, low complication rates, and referral to appropriate discharge settings. Work with post-acute partners to optimize utilization of resources and rehabilitative care post-discharge.
5. Proactively Plan to Coordinate Care: Whether or not collaborator sharing arrangements are right for your organization, plan for a hospital clinical staff person to act in the role of Care Coordinator for all CJR patients through the length of their episode. Use creative strategies and partnerships with post-acute providers to drive down cost and increase quality for CJR patients.
Provider alignment between hospital, physicians, and post-acute providers is critical to success in CJR episode-based the environment. The good news is that CJR allows hospitals to align with providers in a meaningful manner. Through our experience under the Bundled Payment for Care Improvement (BPCI) program, we have learned that even the simplest gainsharing agreements and alignment strategies can quickly become quite complex and difficult to manage. To foster mutually beneficial bundled payment partnerships hospitals must focus on selecting the right partners and designing alignment structures that cleanly incentivize quality improvement and cost reduction across the total joint episode of care.
