Skip to main content

Year: 2018

HHS Confirms Launch of New Mandatory Bundled Payment Models

In remarks to the Patient-Centered Primary Care Collaborative, HHS Secretary Alex Azar confirmed that new mandatory bundled payment models are coming. During his tenure as Secretary of HHS, Azar has consistently signaled that new, required episode-based payment models are coming, and elaborated on those plans in yesterday’s remarks, saying, “We need results, American patients need change, and when we need mandatory models to deliver it, mandatory models are going to see a comeback.” During his speech, Azar doubled-down on his previous statements that mandatory bundled payment models are necessary in order to test efficacy and spur reform, and pointed to savings demonstrated in several common inpatient episodes included in the Bundled Payments for Care Improvement (BPCI) model. He also noted that HHS intends to revisit some of the bundles which were previously scaled back, including episodic cardiac models, as well as introduce new models. Azar went on to specifically mention that HHS is exploring “new and improved episode-based models” for radiation oncology. Azar reiterated that HHS intends to focus on paying for outcomes, rather than processes, saying “We don’t want to be overly prescriptive about how doctors deliver value. We are going to tell you the what that we want—better outcomes at a lower cost—but we’re not going to be overly specific about the how.” The final portion of Azar’s remarks was dedicated to the idea of further empowering patients and their primary care providers to improve the health of populations through prevention, saying: “I want you all to imagine a system where patients are in the driver’s seat, able to shop among providers who are empowered as navigators of patient decisions rather than paperwork; where payments reward outcomes, not box-checking; and where diseases are effectively prevented or cured long before they cause unnecessary suffering and cost.” Read Azar’s full remarks from his speech to the Patient-Centered Primary Care Collaborative Conference here.

Mandatory Bundled Payments on the Horizon

Requiring APMs Necessary to Test Efficacy and Spur Reform, Azar Says

There are continuing indications that mandatory alternative payment models (APMS), including mandatory bundled payments, are coming. During remarks to the Physician-Focused Payment Model Technical Advisory Committee (PTAC) on September 6, 2018, Alex Azar, secretary for the Department of Health and Human Services (HHS), stated, “We need strategies and models that provide better care at a lower price…in some cases that’s going to mean mandatory models from CMMI and other mandatory reforms.”

Continuing Signals for APMs, Including Mandatory Bundled Payments

In November 2017, prior to Azar’s confirmation as secretary, the Centers for Medicare & Medicaid Services (CMS) canceled two mandatory bundled payment models that were scheduled to begin January 1, 2018, which some interpreted as a pivot towards voluntary models. During Azar’s confirmation hearings in January, however, Azar clearly stated his belief that mandatory APMs may be necessary in order to test the efficacy of those programs. During his recent comments to PTAC, Azar doubled down on the need for mandatory models, saying, “Requiring participation can be necessary to determine whether a model really works, but it may also be necessary to meet what we see as an urgent need for reform.”

CMS Administrator Seema Verma noted that forthcoming models will be focused on high-cost areas such as end-stage renal disease, cancer care, chronic disease and other serious medical conditions.

Two-Sided Risk Part of Overall Strategy

In addition to discussing the need for mandatory models, Azar also touched on the recent proposal by CMS to overhaul the accountable care organization (ACO) Medicare Shared Savings Program (MSSP). The proposed changes would move providers into a risk-bearing model more quickly, regarding which Azar said, “…the best results we’ve seen have been in ACOs that took on two-sided risk—where providers have real accountability for outcomes…that’s why we have now proposed to simplify the ACO system into two tracks, requiring them to take on risk sooner.”

For providers, the message is clear—CMS is committed to advancing value-based care through alternative payment models, and mandatory models with two-sided risk are part of that strategy. Mandatory bundled payments are on the horizon, and providers should start laying the groundwork now in order to succeed under these programs.

2018 National Patient Navigation Compensation Survey Results

From late 2017 through early 2018, we invited those working in navigation roles in the U.S. to participate in a patient navigation compensation survey. In addition to questions on pay, survey respondents also provided information on their professional experience, the makeup of their navigation teams, training experiences, and more. It is our hope that the resulting data will provide much-needed industry benchmarks and serve as a useful tool for those serving in these critical roles. More than 400 navigators responded to the survey, including nurse navigators, social workers, lay navigators, care coordinators, navigation managers and more. Navigators from a wide range of health care facilities responded, though a majority of respondents are connected to or work in oncology due to many members of the Academy of Oncology Nurse & Patient Navigators (AONN) being invited and responding to the survey. One of the most significant findings of these survey results is that nurse navigators typically command compensation rates that are higher than the national average for nursing,¹ and non-clinical navigators also have higher earning potential than most other non-clinical roles in health care.² The greatest predictor of compensation rates within this survey was whether the respondent possessed a clinical license, followed closely by years of experience. In addition, the survey revealed that two of the biggest unmet needs for new navigators are additional opportunities to shadow and learn from experienced navigators, and more well-defined onboarding processes overall. We hope that you find the following data useful. If you serve in a navigation role, we’d like to thank you for the critical role you play in improving patients’ health and experience within the health care system.

Download Patient Navigation Compensation Survey Results:

Download the 2018 National Patient Navigation Compensation Survey Results [button link=”https://guidewaycare.com/wp-content/uploads/2018/09/2018-navigation-compensation-survey-results-9-18-18.pdf” size=”medium” target=”_blank” icon=”download” color=”alternative-1″ lightbox=”false”]Download Survey Results[/button]


¹“Occupational Employment and Wages, May 2017: 29-1141 Registered Nurses.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 30 Mar. 2018, www.bls.gov/oes/current/oes291141.htm. ²“Healthcare Occupations.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 13 Apr. 2018, www.bls.gov/ooh/healthcare/home.htm. Editor’s note: The initial version of survey results incorrectly stated that the survey was conducted from “late 2018 through early 2019;” this has been corrected to “late 2017 through early 2018.”

Dr. Edward E. Partridge to Speak at 2018 Healthcare Bundled Payments Conference

  • News
Dr. Edward E. Partridge, Chief Medical Officer of Guideway Care, is slated to speak at the 2018 Healthcare Bundled Payments Conference. The conference is scheduled for September 13-14, 2018 in Las Vegas, NV. Dr. Partridge will draw on his experience as Medical Director of the UAB Health System Cancer Community Network and Director Emeritus and Distinguished Professor of the UAB Comprehensive Cancer Center as he addresses the use of lay navigation to improve quality and reduce the cost of care within bundled payment models. Full details on the conference may be found at: https://www.wcforum.com/conferences/bundled-payments

UAB Medicine Partners With Guideway Care for COPD Care Guidance

  • News
BIRMINGHAM, Ala., Apr 24, 2018: Guideway Care today announced a new care guidance partnership with UAB Medicine for chronic obstructive pulmonary disease (COPD) patients. The partnership aims to improve patient health by providing additional, non-clinical support beyond the hospital stay. Patients in the program receive support and instruction from trained lay navigators, or care guides, through face-to-face, phone and text encounters. Care guidance begins immediately upon a patient being discharged from the hospital and continues for three months, during which the care guides provide one-on-one support and education regarding various aspects of a patient’s treatment plan, ensuring the patient understands medications, completes their prescribed treatment regimens, and is proactive in managing their own health. Care guides also utilize technology tools and reminders to provide patients with additional education and encourage consistency in following a treatment plan. “We know from previous experience at UAB in the realm of cancer care that lay navigators can improve access, coordinate care delivery, and reduce costs for the health system. COPD is one of the leading causes of hospitalization in the U.S., and patients have significant unmet needs that extend beyond the hospital or clinic,” said Anand Iyer, M.D., assistant professor in the UAB Division of Pulmonary, Allergy, and Critical Care Medicine. “We have an excellent opportunity to redesign our care delivery team in ways that can improve outcomes for a large population.” Guideway Care expands upon traditional care navigation models with a care guidance program designed to empower patients and fill in the gaps experienced by those navigating the health care system. Guideway offers a powerful blend of one-on-one coaching and technological support to drive improvements in patient health, lower unnecessary hospital readmissions, and assist hospitals in succeeding under bundled payment models.

About Guideway Care

Guideway Care works with care providers to support patient care post-discharge, achieve better outcomes, improve patient satisfaction and to control the costs of providing outstanding care. At the core of its solution is the training and management of specialized disease-specific Care Guides, non-clinical personnel who assist patients and their families by coordinating care, information, and identifying resources across a broad spectrum of services. In addition, Guideway Care provides proprietary technology solutions and proven protocols to ensure a superior total experience for patients, families, and care providers. Guideway is helping practices meet the requirements of Alternative Payment Models (APMs), including the Bundled Payments for Care Improvement (BPCI) Initiative and the Hospital Readmissions Reduction Program (HRRP).

About UAB Medicine

UAB Medicine comprises the School of Medicine and the $4.3 billion UAB Health System that includes all of the University of Alabama at Birmingham’s patient-care activities and 2,300 licensed beds in six hospitals, one of which is UAB Hospital — the third-largest public hospital in the United States, winner of the Women’s Choice award, and one of U.S. News and World Report’s Best Hospitals. UAB is the state of Alabama’s largest single employer and an internationally renowned research university and academic health center; its professional schools and specialty patient-care programs are consistently ranked among the nation’s top 50. UAB is the largest academic medical center in Alabama and one of the top four largest academic medical centers in the United States. UAB’s Center for Clinical and Translational Science is advancing innovative discoveries for better health as a two-time recipient of the prestigious Center for Translational Science Award. Find more information at www.uab.edu and www.uabmedicine.org.

A New Direction in Cancer Care – American Healthcare Leaders Magazine Interviews Guideway Care COO

  • News

“Working at Guideway Care is one of the most exciting things I’ve ever been able to do in my career,” Graham says. “This company has such a great purpose. We are doing something that improves patient care and population health while making health care more affordable for everyone in the system.”

Read the full article at https://americanhealthcareleader.com/2017/new-direction-cancer-care/.