The team at Colorado prepared an environmental analysis of payment reform, and for a number of years, was engaged in a number of Colorado state initiatives for state-wide bundling in Medicaid and the private sector. Colorado viewed the model as an expansion of a previous demonstration model – this familiarity with the payment model and evidence of cost savings helped minimize the associated risks. Ms. Kissick worked with the American Association of Medical Colleges (AAMC), a convener under contract from Medicare to assist with pilot participation, to create a program to begin in January 2014.
Under the BPCI, participants had the option to choose from one of four models; Colorado chose a 30-day, model 4 bundle. This model utilized prospective payments such that the hospital would receive a single, lump sum payment from Medicare and then distribute that payment among all of the providers involved in the episode of care – and if their costs exceed the budget, Colorado would absorb the extra costs. When compared to fellow BPCI participants, 116 institutions implemented a CHF bundle, with Colorado being the only institution to opt for a 30-day model; others all chose longer time periods (60–90 days).
BPCI makes hospitals financially responsible for services provided if a readmission occurs. For example, CMS would not pay claims for CHF related services provided at Colorado within 30 days of the anchor hospitalization. In addition, for any CHF-related services provided at another hospital, Colorado would be financially responsible for the total payments made during that readmission.