Bundled payments programs have been lauded as primary component in a more modern approach to delivering higher quality, more efficient and cost-effective health care. And, while this model might not be the definitive answer, it certainly has the potential to be a significant step in the right direction.
But, despite the CMS mandate for Comprehensive Joint Replacements (CJR), some providers and payers remain hesitant to get onboard, perhaps out of fear—fear of change in general, the data challenge or the transparency of quality metrics. However, the benefits of a bundled payment network far exceed the challenges, including the opportunity to dramatically increase market share and earn bonuses for high-quality care delivered at low cost.
For hospitals looking to accelerate deployment of a bundled payment program, here are 7 tips to help convince network partners to get onboard the bundled payment bandwagon:
- Financial incentives. Providers who deliver high-quality, low-cost care can qualify for bonuses and other financial incentives. In the case of CJR, surgeons can earn up to 50% more than the standard rate when substantial savings are realized from the bundled arrangement.
- Higher referral volume. Even providers that may not be eligible for direct bonuses can still benefit financially through higher patient referrals. By demonstrating consistent quality care delivery and positive outcomes, these providers will quickly become A-list referral partners for network physicians and hospitals.
- Lower marketing costs. As a result of higher referral volume, participants like post-acute providers, labs and more can cut back on marketing spend and let their quality metrics speak for themselves.
- Access to network-wide data. In a bundled arrangement, providers can see the care path patients follow—or don’t, as the case may be—and the results, to better understand follow-up compliance, what’s working and what’s not. Doctors, for example, can see where and for what a patient has previously been treated, prior test results, related prescribed treatments and outcomes to help diagnose complex issues or develop more comprehensive care plans.
- Streamlined patient management. By participating in a network, providers can handle patient management more efficiently. Shared records mean less administrative overhead, duplication of efforts and manual processing of scheduling, diagnostic results and billing.
- Proactive patient-provider matching. The transparency of quality metrics through a bundled payments program enables providers to see which network participants consistently deliver the best patient outcomes and make better strategic decisions about downstream care. For example, a joint-replacement surgeon may see that one rehab facility has particular success with diabetic patients, while another might show better results for patients with previous cardiac history. This insight can better inform referrals and help patients get the best possible care for their specific situation.
- Dramatically improved patient outcomes. While financial benefits are certainly a primary driver, ultimately, ensuring the best possible outcome for every patient is the definitive top priority for every provider. In a bundled program, providers not only have access to quality metrics, but also the ability to analyze patient characteristics to devise strategic treatment plans to address specific known population risks.
While perhaps a somewhat difficult pill to swallow for some, bundled payments programs enable network participants to benchmark performance, share data, evaluate outcomes and collaborate to proactively improve performance and patient care across the care continuum.