The challenges and benefits of bundled payments and risk-based arrangements is one of the biggest issues facing the healthcare field. Kelly Price, DataGen’s Vice President and Chief of Healthcare Data Analytics, and Stephanie Kovalick, Chief Strategy Officer at Sage Growth Partners sat down to help shed some light on ways to succeed with bundled payments and risk-based payment models. Read more about this conversation in our new installment, “The Future of Payment Reform: How can providers, patients, and payers benefit—and who bears the burden? ” 

As we look ahead to 2017—a year that’s sure to bring changes to the way healthcare is delivered under the new Trump Administration—Kelly Price, DataGen’s Vice President and Chief of Healthcare Data Analytics, sat down with Stephanie Kovalick, Chief Strategy Officer at Sage Growth Partners, to provide expert perspective on the current and future states of payment reform. Download 

It is critical that healthcare executives understand and stay abreast of the implications on their organizations of the rapidly evolving innovation in healthcare payment and delivery driven by Medicare and other payers. This white paper examines areas of opportunity and ways for hospitals to achieve CJR success. Download Now

Hospitals may be the only risk-bearing entities under the Centers for Medicare and Medicaid Services' (CMS) Comprehensive Care for Joint Replacement (CJR) payment model, but there are major implications for post-acute care (PAC) providers.  Based on our review of the CJR program, this white paper outlines the top seven things PAC providers need to know about and act on to be successful partners in this and other emerging payment models. Download White Paper

In July 2015, the Centers for Medicare and Medicaid Services (CMS) proposed its Comprehensive Care for Joint Replacement (CCJR) payment model, a pilot bundled payment program for the most common inpatient surgeries for Medicare beneficiaries—hip and knee replacements, known as lower extremity joint replacements (LEJRs). While CMS’ increasing interest in bundled payments has been apparent, the announcement of this mandatory initiative was a surprise to many, given that the Bundled Payments for Care Improvement (BPCI) demonstration program, initiated in 2013, is still in its early stages.  CCJR would be mandatory for hospitals in 75 Metropolitan Statistical Areas (MSAs). This white paper examines the top ten things every hospital executive should know about the proposed CCJR program, its relationship to the BPCI demonstration, and the implications of this model for other innovative payment models.  Download White Paper

A new approach to data-driven decision making  Healthcare reform initiatives, driven by government, healthcare providers, and payers, are  shifting the focus of care delivery and payment from individual points of service to the whole patient and entire populations. This transition from “volume” to “value” (or population health) requires a mindset change for hospitals, health systems, and other providers. It necessitates an expanded perspective that encompasses the full spectrum of care for patient populations—from primary to post-acute services—to improve health and outcomes while reducing costs. Download Now

"Shock and awe" were words that many of our clients used when they received their Bundled Payments for Care Improvement (BPCI) "mock" reconciliation data from the Centers for Medicare and Medicaid Services (CMS) in early May. Some were dismayed at the significant reduction in financial surpluses from those that were expected, while others were alarmed by several apparent policy changes that have been implemented without notice and after contracts were signed. This article will discuss what we expected to see, what we actually saw, what we see as the consequent effects on reconciliation, and where we believe policy changes must be forthcoming. Download Now

By exploring the regional variations in Medicare payments for 90-day episodes of care (those beginning with a hospitalization that also includes post-acute care), this report provides key findings from an analysis on four different clinical episodes/areas of care: acute myocardial infarction, congestive heart failure, pneumonia and major hip and knee joint replacements. Download This White Paper

The Centers for Medicare and Medicaid Services (CMS) is allowing providers that are already participating in the BPCI program to evaluate expanding their participation to additional episode families. This article provides a structured approach to those providers for analyzing and evaluating new episode families for inclusion in BPCI. Download This White Paper

An overview of the Bundled Payment for Care Improvement, citing the challenges experienced by both participants and CMS, and sharing lessons learned by New York-Presbyterian Hospital and its data analytics partner, DataGen. Download This  Case Study

Contrast in decision points between two hospitals, both participating in the "Major Joint Replacement" episode family. Download This White Paper

A look at the recently released methodology for computing the target prices for the Medicare Bundled Payment for Care Improvement (BPCI) program. Download This White Paper

In this round of the Bundled Payment for Care Improvement (BPCI) project, Centers for Medicare and Medicaid Services (CMS) introduces outlier limits on episode costs Download This White Paper