Positive Outcomes for BPCI-A for Heart Failure Care at Houston Methodist

Heart failure (HF) imposes a substantial health care and economic burden in the United States. The Bundled Payments for Care Improvement — Advanced (BPCI-A) program, launched in October 2018, aims to reduce costs and improve care quality for conditions including HF. National evaluations of BPCI-A have reported modest savings with inconsistent impacts on HF, particularly for readmission rates and post–acute care (PAC) utilization. This program evaluation at Houston Methodist, a BPCI-A participant since inception, assesses the program’s impact on HF care by comparing quality and PAC utilization between Medicare fee-for-service beneficiaries enrolled in BPCI-A and HF patients not participating in BPCI-A. At Houston Methodist, HF care within the BPCI-A program spans admission and postacute phases, coordinated by a multidisciplinary team of value-based care case managers, nurses, social workers, physicians, and care coordinators, who ensure continuity of care from admission through 90 days post discharge. Efforts focus on proactive patient identification on admission, standardized inpatient care, and appropriate postdischarge support. Post discharge, nurses contact patients within 48 hours for medication reconciliation, and high-risk patients receive in-person visits, with facilitation of urgent care appointments. Weekly interdisciplinary rounds guide PAC decisions to prevent readmissions. Clinical episodes from HF admissions (Medicare Severity Diagnosis-Related Group codes 291–293) between October 2018 and December 2021 were analyzed for 30-day and 90-day all-cause readmissions and discharges to home or home health, hospice, and PAC facilities (i.e., long-term acute care, nursing home, inpatient rehabilitation, and skilled nursing facility [SNF]). Of the 2,831 HF episodes analyzed during the study period, 21% were under BPCI-A. The program achieved notable financial savings, with average reconciliation payment savings per HF bundle fluctuating between US$2,735 and US$5,697. Episodes in BPCI-A were more likely to involve older individuals with more comorbidities and shorter anchor stays. Compared with nonparticipating patients, those in the BPCI-A program had fewer 30-day all-cause readmissions (15% vs. 23%) and 90-day readmissions (31% vs. 39%). Among those patients with readmissions (n=1,065), discharges to home or home health were less frequent in the BPCI-A group (69% vs. 80%), while the BPCI-A group was more frequently discharged to hospice care (14% vs. 6%) and PAC or SNF (15% vs. 12%). There was a significant inverse association between BPCI-A and 30-day readmission, but a nonsignificant inverse association with 90-day readmission. HF care under the BPCI-A program at Houston Methodist during the study period was associated with cost savings, fewer 30-day readmissions, and a greater use of hospice and SNF care after readmission.