HealthCare Business News spoke to HealthLoop CEO, Todd Johnson, to get a better understanding of his company's patient engagement platform — which aims at helping providers improve episodic and post-acute care — and what it means for providers aiming to make the most out of bundled payments.

HCB News: CMS’s new Bundled Payments for Care Improvement Advanced (BPCI Advanced) program offers real rewards to providers who are able to improve outcomes. Can you tell us what BPCI Advanced is all about and how your company fits in?

TJ: Sure. First, though, everyone needs to be aware that the timeline for enrolling in the program is extremely tight. The deadline to apply is March 12, 2018—and after that there won’t be another opportunity to enroll for two years. For those who have convictions about improving outcomes, you need to jump now. You can either go it alone or seek a partner convener, someone like naviHealth, to help you get there.

Second, a quick word about the BPCI program. These bundled payment programs are continuing because it has been proven that they work. These payment models incentivize providers with a greater margin wherever they improve patient outcomes and lower costs —meaning that both patients and providers win. Many providers who have been sitting on the sidelines have seen their peers making a lot of money via better care coordination, resulting in better patient outcomes. My belief is that those people on the sidelines have built up a good amount of pent-up demand, and they want to jump onboard with BPCI. And they should! It’s a great opportunity. Providers do need to be ready, though. From a patient care perspective, everyone should consider these programs because with the right amount of work you can improve care and financial performance. The only thing that would make me hesitate as a healthcare provider is if I lacked a good, healthy relationship with my market specialists—the physcians who needs to come to the table and be a good partner in this. If you have that partner and you’re ready to make modest investments in your care delivery redesign, you can thrive.

HCB News: What can providers expect in terms of rewards?

TJ: This variable depends on how smart the provider is with post acute care management, in my view. Today many providers are doing very little to reign in post acute care cost, which means it constitutes a very large area of opportunity. We’re talking about $5,000 per patient per case of new revenue, for example, with a higher-cost procedure like those in orthopedics, spine, or other high-acuity scheduled surgical interventions.

HCB News: Are providers able to calculate or project the likely benefits of participation?

TJ: Yes, to be sure—and they should get a clear sense of that number and the likelihood of reaching it before they enter the program. One of the nice features of BPCI Advanced versus traditional models is that CMS is giving providers pricing ahead of time. By looking at your data and engaging your physicians, you can immediately identify the low hanging fruit. You’ll want to then develop a hypothesis about their ability to truly lower unnecessary costs. (Some of that improvement will have to come from pre-admission engagement, by the way.) You should also go into the program with a solid plan for splitting up the gains in a smart and fair way. With the right economic models and better patient management, providers can really advance everyone’s interests.

HCB News: That’s an interesting point. Do the benefits get evenly spread around?

TJ: One of the things this model still leaves open is it cuts off post acute care providers from being post acute care initiators. What that tells us is that CMS really believes that hospitals and medical groups are in the best position to manage patient outcomes and costs. As compared to the mandatory total joint bundled payment program, CJR, physician groups can take a leadership position and become the initiators of the bundles. Because of this you’ll likely see medical specialty groups getting aggressive and trying to cut out hospitals from a gain sharing perspective, so hospitals need to be mindful about engaging with their doctors early to ensure alignment.

HCB News: What does being “ready” for BPCI entail?

TJ: With these specific programs the first step is “know your data.” Nothing is keeping providers today from downloading their data from CMS to see how they have done in the past. They can do that by visiting https//:innovation.cms.gov/initiative/bpci and downloading a data request and attestation form. Anyone can do that, and everyone should.

Once you’ve made a commitment to jump in, there are a number of things that can be done to drive performance. One is reducing the amount of unnecessary post acute care. By discharging patients to skilled nursing or rehab facilities and carefully monitoring their utilization, or by safely discharging them to their home, providers can improve financial performance while maintaining excellent quality.

The essential tool here is an effective care management team to carefully monitor the patient’s progress once he or she is discharged from the hospital. This management should include a patient engagement platform that gives them accurate, tailored information about what they should do at home and what to look out for. Engaging the patient to be on the lookout for an adverse event is empowering, and it also means they and their providers can identify adverse events early and treat them in cost efficient ways.

Providers need to be able to keep the patient in the loop of course. But caregivers, including family, can be equally critical. If the patient is incapable of accessing or using the engagement platform and reaching out to the clinical team, the family should be on the platform too.

HCB News: So a patient engagement platform is an essential tool in succeeding under BPCI Advanced?

TJ: Yes, it’s a real advantage. What we know is that independent of how providers manage post acute care, using patient engagement, based on our specific experience, costs can be reduced by about $656 per case, and those are dollars that drop straight to the bottom line. To put that in perspective, if I’m a doctor doing total joint replacements and my income per case is $1,500, that’s a 30% increase in payment per case. If you stack that up over a year, that becomes very financially meaningful.

How does the platform achieve those savings? It boils down to two components. The first is that by preparing patients before the procedure, and then having daily interaction with them afterward, physicians can set their expectations and help them understand what they need to do at home. This translates into a net decrease in complications. For instance, if in the week leading up to surgery the patient is diligently doing infection prevention techniques such as using an antibacterial mouth rinse and antibacterial washes, there will be fewer incidences of surgical site infection after discharge. And if every day post surgery the patient is increasing blood flow through ankle turns and other exercise, they are at a lower risk for blood clots.

The second component is early detection when there is a problem. The patient engagement platform can detect issues early and then the care management team can direct patients to come into the clinic. An office consult, of course, is much less expensive than an ER visit. Or, instead of a hospital readmission the patient is seen in the ER—a kind of “downshift” effect.

Patient engagement platforms can keep patients on their plan and resolve events earlier, containing costs and improving outcomes. This is where providers are going to benefit under BPCI.

HCB News: Can you provide other instances?

TJ: Yes. We know that patients who have a smart diet leading up to surgery have better outcomes and heal faster, and those who clean up their house to reduce tripping hazards after surgery have fewer calls at home. Patient engagement technology helps by setting an attitude even before the procedure takes place. A patient who goes into the procedure with the right mind set and bodily condition makes a huge difference in recovery.

Also, we know that certain activities after discharge really reduce the incidence of adverse events. One of these is ambulating properly. Through patient engagement platforms, we can closely monitor their signs and symptoms after discharge so we can prevent or limit adverse events. Working with a care management team who is engaged through the platform becomes a real game changer. Every patient gets the benefit of the continuous conversation with the medical team really 30 days before admission and 90 days after discharge. This allows providers to focus not just on the 3-5% of patients with serious issues but with 100% of the patients to deliver a truly exceptional experience to all of them It also reduces the drag on patients and providers so that they can work efficiently. We will discuss these and other benefits of these platforms in a separate article in DOTmed Healthcare Business News.