CMS BPCI Initiative Models 2-3: Year 4 Evaluation ...

CMS Bundled Payments for Care Improvement Initiative

Models 24: Year 4 Evaluation & Monitoring Annual Report

Prepared for:

CMS

Prepared by:

The Lewin Group

With our partners: Abt Associates, GDIT, Telligen, and Optum

June 2018

CMS Bundled Payments for Care Improvement Initiative Models 2-4: Year 4 Evaluation & Monitoring Annual Report

The Lewin Group Authors:

Laura Dummit, Grecia Marrufo, Jaclyn Marshall, Tristan Ackerman, Sarah Bergman, Aylin Bradley, Rebecca Cherry, Inna Cintina, Daniel Cooper, Syvart Dennen, Philip Dishuck, Ayah Fannoun, Megan Hyland, Gina Gerding, Dan Gregory, Catherine Griffin, Ashley Johnson, Susan Joy, Jordan Kahn, Jon Kelly, Alex Lampert, Karla Lopez de Nava, Brandon Maughan, Court Melin, Sebastian Negrusa, Julie Somers, Dan Strubler, Katarina Swanson, Ellen Tan, Kyi-Sin Than, Peter Weidner, Ayanna Williams, Grace Yang, David Zhang, Dean Farley, Ian Breunig, Andrea Hassol, Qian Gu, Sean McClellan, Matt Trombley, Christine LaRocca, Becky Blystone,

Colleen Kummet

Lewin's address: 3130 Fairview Park Dr, Suite 500, Falls Church, VA 22042

Federal Project Officer: Daver Kahvecioglu

Division of Data, Research, and Analytic Methods (DRAM) Research and Rapid Cycle Evaluation Group (RREG), Center for Medicare and Medicaid Innovation (CMMI), Centers for Medicare and Medicaid Services (CMS)

This project was funded by the Centers for Medicare & Medicaid Services under contract no. HHSM-500-2011-00001I Task Order HHSM-500-T0007.

The statements contained in this report are solely those of the authors and do not necessarily reflect the views or policies of the Centers for Medicare & Medicaid Services. The Lewin Group assumes responsibility for the accuracy and completeness of the information contained in this report.

Final June 2018

CMS BPCI Models 2-4: Year 4 Evaluation and Monitoring Annual Report

Table of Contents

EXECUTIVE SUMMARY ...........................................................................................................1 A. Structure of the Initiative ...................................................................................................1 B. Evaluation Design .............................................................................................................2 C. Results ...............................................................................................................................3 D. Discussion and Conclusion................................................................................................8

I. INTRODUCTION ................................................................................................................10 A. BPCI Initiative.................................................................................................................10 B. Research Questions .........................................................................................................12

II. METHODS ............................................................................................................................13 A. Data Sources ....................................................................................................................13 B. Claim-based Analyses .....................................................................................................16 1. Study Population ......................................................................................................16 2. Measurement Periods...............................................................................................17 3. Outcome Definitions.................................................................................................17 4. Difference-in-differences Methodology....................................................................18 C. Beneficiary Survey ..........................................................................................................21 1. Study population.......................................................................................................21 2. Outcome definitions..................................................................................................22 3. Survey Analytic Methodology...................................................................................23

III. MODEL 2 IMPACT OF BPCI ............................................................................................26 A. Sample Characteristics ....................................................................................................27 B. Key Payment, Utilization, and Quality of Care Outcomes..............................................30 1. How have the average standardized allowed amounts (Medicare payments and coinsurance/copayments combined) changed under BPCI?....................................30 2. How have the services changed under BPCI? .........................................................35 3. Are participants shifting services outside of the episode period or increasing services not included in the bundle, which may reduce overall savings to Medicare? .................................................................................................................40 4. How has quality of care changed under BPCI?.......................................................43 C. Change in Patient Mix .....................................................................................................46

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Final June 2018

CMS BPCI Models 2-4: Year 4 Evaluation and Monitoring Annual Report

IV. MODEL 3 IMPACT OF BPCI ............................................................................................50 A. BPCI Participating SNFs .................................................................................................51 1. Sample Characteristics ............................................................................................51 2. Key Payment, Utilization, and Quality Outcomes....................................................52 3. Changes in Patient Mix ............................................................................................59 B. BPCI Participating HHAs................................................................................................64 1. Sample Characteristics ............................................................................................64 2. Key Payment, Utilization, and Quality Outcomes....................................................64 3. Changes in Patient Mix ............................................................................................67

V. NET SAVINGS TO MEDICARE .......................................................................................70 A. Methods ...........................................................................................................................70 B. Results .............................................................................................................................72 1. Model 2 ACH............................................................................................................72 2. Model 3 SNFs ...........................................................................................................74 3. Model 3 HHAs ..........................................................................................................75 C. Discussion........................................................................................................................76

VI. DISCUSSION AND CONCLUSION ..................................................................................78 A. Discussion........................................................................................................................78 B. Limitations.......................................................................................................................79 C. Future Analyses ...............................................................................................................80 D. Conclusion .......................................................................................................................81

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Final June 2018

CMS BPCI Models 2-4: Year 4 Evaluation and Monitoring Annual Report

List of Appendices

APPENDIX A: GLOSSARY OF TERMS & ACRONYM LIST..................................... A-1

APPENDIX B: BPCI CLINICAL EPISODES AND MEDICARE SEVERITY DIAGNOSIS RELATED GROUPS (MS-DRGS)....................................B-1

APPENDIX C: COUNT OF EPISODE INITIATORS AND EPISODES BY MODEL, EPISODE INITIATOR TYPE, AND CLINICAL EPISODE, Q4 2013 Q3 2016.................................................................. C-1

APPENDIX D: CONSTRUCTION OF COMPARISON PROVIDERS AND EPISODES.................................................................................................. D-1

APPENDIX E: COMPARISON GROUP STANDARDIZED DIFFERENCE TABLES.......................................................................................................E-1

APPENDIX F: CLAIM-BASED OUTCOME DEFINITIONS ........................................F-1

APPENDIX G: ADDITIONAL VARIABLE DEFINITIONS.......................................... G-1

APPENDIX H: MODEL 2 ACH BENEFICIARY SURVEY RESPONSE RATES AND ADDITIONAL RESULTS .............................................................. H-1

APPENDIX I:

IMPACT OF BPCI ON ALLOWED PAYMENT, QUALITY, AND UTILIZATION MEASURES, BY CLINICAL EPISODE, BASELINE TO INTERVENTION, MODEL 2 ACH ..............................I-1

APPENDIX J:

GROUPS OF MODEL 2 CLINICAL EPISODES BASED ON SHARED CHARACTERISTICS WITH IMPLICATIONS FOR COST SAVING STRATEGIES ................................................................ J-1

APPENDIX K: IMPACT OF BPCI ON ALLOWED PAYMENT, QUALITY, AND UTILIZATION MEASURES, BY CLINICAL EPISODE, BASELINE TO INTERVENTION, MODEL 3 SNF ............................. K-1

APPENDIX L: IMPACT OF BPCI ON ALLOWED PAYMENT, QUALITY, AND UTILIZATION MEASURES, BY CLINICAL EPISODE, BASELINE TO INTERVENTION, MODEL 3 HHA.............................L-1

APPENDIX M: MINIMUM DATASET (MDS) AND OUTCOME AND ASSESSMENT INFORMATION SET (OASIS) OUTCOME DEFINITIONS .......................................................................................... M-1

APPENDIX N: NET SAVINGS TO MEDICARE ............................................................ N-1

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