Harm Prevention

Provider-based Impact Deep Dive:
Bundled Payments

As part of a drive toward innovation, the Centers for Medicare & Medicaid Services (CMS) continues to roll out episode-based payment initiatives focused on improving cardiac and orthopedic care.
These programs include the current Comprehensive Care for Joint Replacement (CJR) model and proposed:
  • Acute Myocardial Infarction (AMI) Model;
  • Coronary Artery Bypass Graft (CABG) Model;
  • Surgical Hip and Femur Fracture Treatment (SHFFT) Model; and
  • Cardiac Rehabilitation (CR) Incentive Payment Model
This intelligence along with a patient’s clinical history are mapped within the machine’s Eigen-based architecture to pin point the interventions that will drive the highest levels of engagement for each individual patient. With this propensity information, clinicians can better align clinical actions and resources to the patients who are most likely to benefit and engage with specific care activities and interventions.
These models all share common goals aimed at enabling collaboration, communication, and prevention; and improving the quality and efficiency of care for Medicare patients. The distinct feature of episode-based payments is the incentive to deliver better care at a lower cost from the time a patient is admitted through 90 days post-discharge.
The carrots and sticks that are core to the program have helped to deliver significant savings across participating providers. In a recent study published in JAMA Internal Medicine, covered episodes under the current CJR saw a decrease of $5,577 or 20.8%. New bundles, which are scheduled to go live in July 2017, will extend the current program to include patients admitted for heart attacks, bypass surgery, and/or cardiac rehabilitation following a heart attack or heart surgery. The CJR program will be replaced by the SHFFT model, which extends the covered treatments to include patients who receive surgery after a hip fracture.
Mastering your CJR patient population means that your patients are healthier, you better allocate your resources, and that you avoid potential repayments to Medicare at the end of the model performance year.
Jvion's Cognitive Clinical Success Machine is specifically designed to help providers manage at-risk, episode-based bundled payment models by empowering providers with a high-definition view into patient predispositions, risk manifestations, that the actions and interventions that will:
  • Identify - at the time of admission - patients who are likely to have a nosocomial event
  • Optimize the inpatient length of stay
  • Stop 30/60/90 day readmissions
  • Align patients that the post-acute care environment that will drive the best quality outcomes
  • Reduce risk across care transition points
  • Enable the best care action paths to improve outcomes while reducing costs
Jvion's Cognitive Clinical Success Machine accounts for the massive and complex body of patient data including the exogenous factors that account for 60% of a person's health outcomes. The machine does this using a quadrillion cognitive machine dimensions and up to 10,000 factors to enable a high definition view of the patient 30, 60, 90 and up to 365 days into the future. This view accounts for the full patient portrait of risk across all care settings and enable the best action paths that will prevent avoidable complications and improve outcomes. When applied to a specific bundle, providers are enabled with the tool and recommendations they need to drive individualized interventions at every point across the episode of care.
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