Archway Health, a full-service, tech-enabled partner to healthcare organizations in risk-based payment programs, today announced the Patient Case Mix Adjustment (PCMA) Tool in Archway Analytics that allows providers to understand how the case mix of their patient population will impact their performance in the Bundled Payments for Care Improvement (BPCI) Advanced program. Believed to be the first of its kind, Archway’s PCMA function complements the existing patient-specific target pricing features of Archway Analytics to further aid providers in achieving savings in the program.
Target prices – what providers strive to manage costs below in value-based payment programs – involve complex pricing methodology set by the Centers for Medicare & Medicaid Services (CMS). With the introduction of BPCI Advanced in 2018, CMS began adjusting providers’ target prices to account for patient population factors out of their control such as age, comorbidities, and dual eligibility. CMS implemented the patient case mix adjustment to give providers more fair pricing based on their own populations, rather than those of their peers, which also created a wide variation in target prices for the program’s episodes of care. Archway Analytics uses patient-specific, risk-adjusted target prices and a proprietary proration methodology to calculate a participant’s financial performance at the individual episode level, whether that episode is concluded or in progress.
“Providers applauded the patient case mix adjustment in BPCI Advanced, but the variation has also made it difficult for providers to know how they will perform until the moment of truth – known as reconciliation – six months later,” said Keely Macmillan, SVP of Policy & Solutions Management. “Among our Cohort 1 applicants, we saw standardized target prices for one outpatient cardiac episode ranging from $13,000 to $26,000. With that in mind, it is imperative that providers have a tool to predict and control costs if they are expected to achieve positive clinical and financial outcomes with consistency in BPCI Advanced.”
In addition to projecting financial performance, Archway’s PCMA dashboard provides detailed analytics for participants to better understand their patient population. The tool helps providers assess the conditions and comorbidities of their patients, evaluate their documentation practices, understand the impact documented case mix has on target prices, and identify strategies to improve patient care. As the healthcare landscape continues to shift towards value-based payment models, these insights are critical for understanding the mechanics of reimbursement and ultimately, achieving savings in programs like BPCI Advanced.
To learn more about the PCMA tool and other Archway Analytics capabilities, providers can visit Archway’s website and request a demo.
About Archway Health
Archway Health, founded in 2014 and built on a deep foundation of healthcare payment reform expertise, works with providers and employers to design and execute care and risk management initiatives that improve care and reduce costs. Archway is currently working with leading healthcare providers participating in risk-based contracts including CMMI bundled payment programs such as BPCI Advanced, OCM, and CJR. Archway also works with Medicare and commercial ACOs, self-insured employers, and commercial payers. To support these programs, Archway collaborates with organizations to analyze their opportunities and risks, and deploys a comprehensive platform of analytics, patient tracking tools, Value-Based Risk Protection stop-loss programs, and advisory services. For more information, please visit www.archwayhealth.com.