Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care

ABSTRACT

The Centers for Medicare and Medicaid Services Innovation Center’s Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider’s approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

KEYWORDS:

• Bundled payments
• community and home care
• congestive heart failure
• home health care

Acknowledgments

The authors extend a special thank you to Susan Northover, Dr. John Delfs, Dr. Timothy Peng, and Eni Balkballeshi for each of their additional reflections and contributions to this very important body of work. The authors also acknowledge Dr. Barbara Turner, Dr. Paula Milone-Nuzzo, Charles Wiggins, and Tracey Moorehead for their expertise and participation in this scholarly work. The authors declare no conflict of interest. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.