Bundled payments: a holistic approach to patient care

Institute for Health Care Improvement
Bundles and Buy-Ins for Value-Based care
March 12, 2p ET

Guest speakers:
Mark Jarrett
Susan Browning
Alice Ehresman
Mark Hiller
Kathy Luther

Last week CMS announced a new innovative payment and care deliver model for Accountable Care Organizations (ACOs), called the Next Generation ACO Model. This model requires participating providers to ‘shoulder more financial risk’. This new value based reimbursement was no doubt created due to the success that bundled payments and the Pioneer ACO program have had. In this bi-weekly Institute of Healthcare Improvement (IHI) audio broadcast the focus was on bundled payments for Care Improvement. For those of us new to the various innovations being implemented to improve patient care, bundled payments have the additional potential to save healthcare systems big bucks.

Healthcare Delivery Systems involved in Bundled Care.

Healthcare Delivery Systems involved in Bundled Care.

A thorough, but brief introduction from IHI’s own Kathy Luther was given on the roles of teams and leadership in value driven care redesign. Considering Kathy’s role with the IHI to “help hospital leaders and staff achieve bold aims” her presentation outlined structure strongholds that are vital for tackling value based payment reform. Baystate Medical Center, North Shore LIJ and Premier discuss their experiences and thoughts on these roles.

At Baystate Medical Center, Alice Ehresman has the role of ‘Nurse Bundled Navigator’ (later mentioned as a imperative role for ACOs). She provides real time data metric dashboards to physician groups that are currently involved in Phase II, Model II of total joint replacement and coronary heart bypass surgery bundles. Their success relies heavily upon heavy buyins from the team, strong management of post-acute care resources and a ‘champion’ physician role that is engaged/educated in bundled improvement work. Baystate ‘transparent’ monthly meetings on bundled care has also been vital towards their success which is exemplified in the increase of attendees.

North Shore LIJ had two speakers, Mark Jarrett, MD & Susan Browning, MPH. Mark was very straightforward with how it has been difficult to get physicians, especially procedure orientated physicians like surgeons, to look at the whole continuum of care- from focusing on discrete data points and processes to looking at the big picture of patient outcomes. Physicians have concerns that they are put at risk for part of their compensation because they are not able to fully impact the outcomes of the patients throughout the continuum of care after they leave the surgeons table. Another issue that physicians are bringing to attention is the lack of evidence based metrics. North Shore has also had issue with patients not being discharged to a post-acute environment ; it’s difficult to keep communication clear on negative impacts on one site vs. positive on another.

Mark Hiller also spoke about bundled payment influence on Premier. Mark has a background in financial analysis and developing practical tools to assist hospitals in reducing their costs, so naturally he is involved in bundled payment reform. Mark mentioned the shock some physicians displayed upon learning what their patient went through 90 days post discharge, and in some cases this was the first time they had learned as much. I think this is an extremely interesting comment because it exemplifies how broken the fee for system is in providing holistic care to a patient. He focused a lot on the importance of communication with physicians about bundled payments and that understanding post-acute utilization will be imperative.

One thing that struck home with me was the ‘Culture of transparency and working together’ theme that was mentioned throughout the one hour broadcast. Does value-based care success rely solely on this statement alone? What do you think? Please post any comments you may have below.

Up next with IHI is Managers and Management: We need to improve care on March 26, 2015.

Links to the audio, slides and chat can be found here.

Posted in: Healthcare transformation

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