Program Design & Implementation

When introducing new programs and policies to the public, clients often require data and analytic support throughout the development and implementation phases. Acumen is an industry expert in supporting the design and implementation of public health care delivery programs and payment systems in a wide range of care settings, including skilled nursing facilities, outpatient services, physician reimbursement, and the End Stage Renal Disease (ESRD) Medicare benefit. Underlying many of these programs and policies is a strategy for instituting accountability for positive health care outcomes through organized incentives that reach providers in all levels of care.

Acumen possesses a specialized knowledge in developing these incentive compatible structures and projecting the large-scale changes to payments and market structure resulting from proposed policies. Acumen also leverages our robust IT infrastructure to facilitate the data sharing, communication, and technical assistance to clients, partners, and participating health care providers required for implementing such policies.

Case Study:

Bundled Payments for Care Improvement (BPCI) Auditing and Payment Reconciliation; 2015-present; Prepared for the Centers for Medicare & Medicaid Services (CMS), Center for Medicare & Medicaid Innovation (CMMI)

The Bundled Payments for Care Improvement Initiative, tested under the authority of CMS' Innovation Center (CMMI), is a reimbursement model that involves a patient-specific, bundled payment arrangement where actual expenditures are reconciled against a target price for an episode of care.

Working on the audit team of the original model, Acumen conducted conceptual validations to determine the validity of model design and operationalization. In conducting these validations, Acumen identified several areas of the methodology that could be improved upon to ensure that participants receive accurate prices for each bundle and are treated fairly regardless of the demographics and case mix of their patients.

Based on these findings, CMMI engaged Acumen to develop and implement the pricing mechanism of the next version of the BPCI initiative, BPCI Advanced. Acumen works with our clients to continuously refine the specifications of the new model, using sophisticated modeling techniques and diverse simulations to test its capability to accurately price a clinical episode. Additionally, for the new BPCI model, Acumen not only designs, but also provides implementation support for the model’s participating hospitals and physician group practices (PGPs.)