HCI3 Update from the Field: Another Page Has Turned

Submitted by francois.debrantes@hci3.org on Friday, March 2, 2012 - 01:00

Newtown, CT – March 2, 2012

On Wednesday, potential CMMI Bundled Payment applicants received their 70 plus files of Medicare claims. In addition, CMS awarded its contract to build a public domain episode grouper – Another page has turned. For the first time in our history, providers now have access to two years' worth of Medicare claims data, which should help them analyze their past performance, and, if they're forward-thinking and courageous enough, to apply for the CMMI Bundled Payment pilot. With our colleagues from Brandeis University, and programmers extraordinaire G Liu and BNL, we're doing our part in supporting this important effort by making freely available a comprehensive analysis package designed specifically to conform to the Bundled Payment pilot specifications. It won't be fully ready until Tuesday March 7th, but anyone interested in the package can download the instructions today, register, and will receive an email as soon as it's available for download. Our mission has been, and is clear: to help transform US health care by designing, implementing and reporting on incentive programs that improve quality and affordability. Offering this analytic package to the country is part of that mission. And consistent with that spirit, it's with some degree of pride and much honor that, along with our colleagues from Brandeis University, the AMA-PCPI, and the ABMS Research and Education Foundation, we now take on the charge of building the Public Domain Episode of Care Logic for CMS. The competition from 3M, Optum and Thomson-Reuters was formidable, which makes the award all the more meaningful to us.

What this means to you – The lack of a standard definition for an episode of care has been a significant barrier to expanding the scope and reach of bundled payments. Why? Because without that standard definition, anyone can come up with one, thus confusing physicians and hospitals. Those days should now be behind us, and will be. Through this federal effort, we will be defining enough episodes to cover over 80% of Medicare spend, and will also make sure that they cover at least as much in commercial spend. As a result, application builders who are creating the operational infrastructure to pay providers using bundling methods, and who are creating the consumer-facing tools to help patients evaluate the merits of one provider's bundled price over another, can all use the same definitions. In much the same way as all understand what is a measure of blood pressure, all will understand what is contained within an episode of diabetes, or heart failure, or total knee replacement. This is a new day in US health care; a new dawn. Seize it.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org