The Center for Medicare and Medicaid Innovation (CMMI) has developed and implemented multiple bundled payment programs in the past few years. These include:
- Four voluntary Bundled Payments for Care Improvement (BPCI) models
- The mandatory Comprehensive Care for Joint Replacement (CJR) model
- The voluntary Oncology Care Model (OCM)
- Three mandatory Episode Payment Models (EPMs) surrounding cardiac and orthopedic procedures.
CMMI provides regular claims data feeds to all participants. Understanding the contents of these claims data feeds is key to managing a successful bundled payment program.
Milliman has the expertise and claims data analytics to support participants in Medicare bundled payment programs, including BPCI, CJR, OCM, and the EPMs.
Milliman’s Bundled Payment Reporting Interface allows providers managing episodes of care to view and analyze all services provided to patients, supporting efforts to better manage episodes. The interface is built using the claim data provided by CMS, and our programming replicates the logic used by CMS to identify episodes of care. Users can analyze utilization patterns over time and drill into the detail of individual patients to identify cost savings opportunities.
Milliman has developed a dynamic claims interface that provides self-service data visualization and guided analytics. Data can be filtered based on the time period, operating surgeon, beneficiary demographic characteristics, or other criteria. Users can log on to the interface and access personalized, comprehensive reports prepared by Milliman. These reports include all the episodes that we have identified in the claim data feeds provided by CMMI. There are several types of reports in the Milliman Bundled Payment Reporting Interface, including:
- Overall episode costs
- Anchor hospitalizations and related expenditures
- Post-acute care costs
- Post-acute facility profiling
- Patient journey and patient-level details
- Provider profiling
- Episode exclusions
- Claims lag
- Reconciliation and baseline data