3. www.archwayhealth.com
Archway Health – Making Bundled Payment Simple
3
Unique team of healthcare operators, big data analysts, tech developers
We are a Convener in the CMS BPCI program & we support other BPCI Conveners
Currently working with over 50 providers of all types (Hospital, Physicians
Groups, SNFs, HHAs) to manage their bundled payments programs.
Built a comprehensive bundled payment platform including: Patient Tracking, Web-based
Claims Data Analytics, Advisory Services, Preferred Provider Networks & Risk Sharing
Focus
To Partner with providers &
payors to execute bundle
payment programs
Mission
To fix healthcare through
payment reform
4. www.archwayhealth.com
Bundle Payment Initiatives Market Size Key Participants*
Bundled Payment for Care
Improvement (BPCI) - CMS
• 6,700 applicants
• 1,520 participants
• $8-10B of healthcare spend*
• 720 Skilled Nursing facilities
• 410 Hospitals
• 180 Hospitalists groups
• 100 Orthopedic groups
• 100 Home Health Agencies
Oncology Care Model (OCM)
- CMS
• 125 applicants
• $2B in HC spend*
• Oncology groups
• Hospital systems w/Cancer services
Comprehensive Care for
Joint Replacement (CCJR) -
CMS
• 800 Hospitals
• $3B in HC spend*
• All Hospitals in 67 MSAs
State Programs • Hundreds of Millions • States: OH, TN, AK
• Specialties: Ortho, OB, Geriatrics
Commercial Market • Billions • Self-Insured Employers
• Health Plans
• ACOs
• Unions
* Estimated based on publicly available information
Bundled Payment Overview
CMS Better, Smarter, Healthier Initiative
• $300B of Medicare spend in alternative payment models by 2018
• Also encouraging commercial plans to participate
Medicare is pushing aggressively toward new payment models, with bundled payment playing a key role.
4
5. www.archwayhealth.com
Bundled Payment Overview
5
Bundled payment programs create unique new opportunities for key specialists and acute care
providers to benefit from improved care transition and coordination efforts.
• Providers responsible for the full
episode of care
• Episode prices established up front
• Meet episode specific quality metrics
• Coordinate care along the continuum
• Track patient progress
• Respond to “red alerts” when patient
has complications
• Opportunity to access new revenue
sources
Provider as Healthcare “General Contractor”
6. www.archwayhealth.com 6
Major Joint Replacement (DRG470)
Bundle Price Benchmarking
90 Day Episode
$9,400
We often see significant variation in the cost of a bundle across providers, clinical conditions and regions.
$8,400
$7,800
$-
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
DME
LTCH
IRF
SNF
HHA
Readmission
Out-patient
Part B
Index Hospital
Searching for the Best - Select Analytics
7. www.archwayhealth.com
Searching for the Best - Select Analytics
7
Skilled Nursing Facility
Mean Episode Costs
90 Day Episodes
We have also seen dramatic differences in historical performance of Skilled Nursing Facilities.
8. www.archwayhealth.com
Searching for the Best - Select Analytics
8
OCM Opportunity Analysis by Cancer Type
6 Month Episodes
There is also broad variability in the cost of cancer care
9. www.archwayhealth.com
Sources of Savings
Pricing variability
• High priced hospitals vs.
lower priced hospitals
• Inpatient vs. outpatient care
• Hospital outpatient vs.
freestanding outpatient
services
• Resource utilization
• Post-acute services
• Diagnostics
• Coordinated care
Bundle Cost Variation – Hip
Replacement
Searching for the Best - Select Analytics
9
$-
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
Min Max
The BCBS Association has also highlighted significant variation in the commercial market.
Commercial Market Variability
10. www.archwayhealth.com
• Patient reported health status
• Patient goals
• Physical function
• Quality of life
• Clinical measures
• Complications
• Readmissions
• Key clinical stats
• Patient satisfaction
• Provider communication
• Overall experience
• Employer measures
• Back to work
• Physical function
10
Source: International Consortium for Health Outcomes Measurement (ICHOM)
ICHOM Standard Metrics
Bundled payment enables focused, condition specific quality and outcomes measures.
Condition Specific Quality Metrics
Searching for the Best – Quality Metrics
11. www.archwayhealth.com
Payment Reform Market Evolution
11
Fee-for-Service
Pay-for-Performance
Select Bundles
Global Cap
Global Cap + Bundles
Payment Reform Value Progression
Provider Driven
Demand
Consumer Driven
Demand
Specialist engagement & accountability, driven by bundled payment initiatives, have the potential to
reduce trend even further within traditional global cap programs.
Shared Savings
Bundle-Driven PPO
12. www.archwayhealth.com
Payment Reform Market Evolution – Bundled PPO
12
Orthopedics
Hip & Knee
Replacement
Spine Procedures Sports Procedures
Urology TURPs Bladder Surgery UTI
Obstetrics Normal Deliveries High Risk Deliveries Neonates
Gastroenterology Endoscopy Bowel Obstruction Cholecystectomy
Cardiology AMI CABG/PTCA CHF
Cancer Breast Lung Colorectal
Chronic Care Diabetes COPD CHF
• Traditional PCPs • Urgent Care Centers
• Convenience Care • Remote Care – (Web, Telehealth)
Primary Care Services
Bundled Specialty Services
• Un-Bundled Specialty Care • Out of Network Services
• Emergency Care • Sub-Specialty Services
Other Services
PPO Product Elements
• No PCP gatekeeper
• Bundled Payment Value Engine
• Bundle specific quality
metrics
• Bundle pricing w/ warranties
• Outlier protections
• May need to start
with shared savings
model
• Patient incentives
• Shared patient savings if
bundled specialists are
chosen
• Out of network options at
higher cost
• Aligns well with high deductible
and Tiered Co-Pay plans
The long term goal is to create a comprehensive PPO product that drives value across many conditions
through the bundled payment model.
