naviHealth Announces Participation in Groundbreaking Program to Reduce Costs, Improve Outcomes for Medicare

Company to Serve as Convening Organization for Five Health Systems under CMS’s Bundled Payments for Care Improvement Initiative (BPCI)

NASHVILLE, Tenn.--()--Furthering its commitment to improving the coordination of care and to reducing costs across the healthcare spectrum, naviHealth announced its participation in the Bundled Payments for Care Improvement Initiative (BPCI.) The company will serve as the convening organization for five of the nation’s leading health systems. Under these arrangements, naviHealth will manage the care that Medicare beneficiaries receive after a hospital discharge and assume financial risk for the utilization of all post-acute services including hospital readmissions.

The Centers for Medicare and Medicaid Services (CMS) recently announced the BPCI initiative, which is made possible under the Affordable Care Act and will aim to enhance coordination of care for beneficiaries and to lower costs for Medicare through bundling payments for episodes of care. “The objective of this initiative is to improve the quality of health care delivery for Medicare beneficiaries, while reducing program expenditures, by aligning the financial incentives of all providers,” said Acting Administrator Marilyn Tavenner.

naviHealth’s partnerships will operate under Model 2 of the BPCI. Under this model, the episode of care will include the hospital inpatient stay and all related services during an episode up to 90 days post hospital discharge.

“Increasingly, the healthcare environment is moving in a direction where being able to drive coordination of care, finding value-based solutions, and achieving measurable outcomes will be the primary aim – which is exactly what this initiative will work to accomplish,” said Clay Richards, naviHealth president. “We are excited to work with these forward-thinking and highly respected health systems to improve coordination of care for beneficiaries and reduce costs for Medicare through this effort.”

naviHealth will serve as the awardee convener for the following health organizations:

  • Lovelace Health System (Albuquerque, NM), part of Ardent Health Services.
  • Hillcrest HealthCare System (Tulsa, OK), part of Ardent Health Services.
  • MissionPoint Health Partners (Nashville, TN), affiliated with St. Thomas Health and part of Ascension Health.
  • Our Lady of Lourdes Medical Center (Camden, NJ), part of Catholic Health East.
  • St. Bernardine Medical Center and Community Hospital of San Bernardino (San Bernardino, CA), part of Dignity Health.

“We are excited to be taking part in the BPCI program,” said Tom Scully, chairman of naviHealth. “Since my days at OMB in the 1980s, I have advocated that the incentives of Fee for Service Medicare are at odds with quality, efficient patient-centered post-acute care. I wish I had done more to focus on properly aligning these incentives in my tenure as CMS Administrator, and I am very happy that CMS is using these demos to drive the system to finding the most optimal care pathways. These demos are taking the first steps to finally align provider financial incentives—which is always the essential step to delivering improved patient care and improved taxpayer value. Finally, we are on the cusp of modernizing post-acute care—and we are glad to be working with CMS to create that wave.”

About naviHealth

naviHealth partners with health plans, health systems, accountable care organizations and post-acute providers to manage the entire continuum of post-acute care. We utilize evidence-based protocols and technology enabled services to optimize care and align all stakeholders. naviHealth has over twelve years experience managing post-acute care and currently serves over one million Medicare lives in 15 states.


Carter Paine, 615-577-1912


Carter Paine, 615-577-1912