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Benchmarking Bundled Payments: Medicare PAC Utilization Benchmarks
The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payment for Care Improvement Initiative (BPCI) with more than 150 awardees going live in October 2013 or January 2014. These organizations selected from the 48 family/episode option made up from 179 "anchor" DRGs, and many are adding more episodes to their initial selections. Many more organizations have recently received data to let them analyze joining the program with a January 1, 2015 start.

The opportunity to reduce Medicare claims costs is typically in the post-acute care (PAC) period. Analyzing the opportunity to reduce Medicare PAC spending requires providers to adopt a payor state of mind, with payor tools and approaches being very helpful. Benchmarking to best practices is one of those tools.

Milliman has developed nationwide average and well-managed benchmarks for PAC periods of 1-30, 31-60 and 61-90 days. These benchmarks include the percent of each DRG with use of each service and for all, except home care, the average number of days these services were used: readmissions; long-term acute care, inpatient rehabilitation, SNF, and home care.

During this presentation, examples are provided of PAC benchmarks for selected DRGs to highlight the importance to BPCI awardees of benchmarking claims data experience in order to select episodes; set targets for utilization reduction of relevant PAC services; establish programs to more efficiently manage the utilization of key PAC services; and monitor performance toward targets.

Please join us Thursday, November 13th, 2014 at 2:00 PM Eastern as Milliman's Kate Fitch conducts an expert, in-depth session on Medicare Bundled Payment PAC Utilization Benchmarking. Click here for detailed information and to register or call 209.577.4888.
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