Bundled payments save money for big employers, improve care coordination, PBGH exec says

Olivia Ross-associate director, Pacific Business Group on Health’s New Initiatives division

When it comes to bundled payments, payers and providers need to think about how bundled payments can improve the coordination of care, said Olivia Ross, associate director with the Pacific Business Group on Health's New Initiatives division.

Speaking at Thursday's meeting of the Maine Health Management Coalition, Ross said that, even when factoring in waived copays, negotiated bundled payments for surgical procedures performed by the PBGH-affiliated Centers of Excellence cost employers like Walmart, Lowe's, and JetBlue considerably less on average than what employers typically pay, she said.

These cost savings are further bolstered by avoiding unnecessary surgeries and achieving lower rates of expensive complications.

"There's an opportunity to use bundles to leverage the coordination of care," said Ross. "There are people involved in the same process, in the same building, who don't realize that maybe they should be talking to each other. All of these silos exist."

[Also: Healthcare orgs ask CMS for changes to cardiac bundled payment programs ahead of rollout]

Two main types of bundles exist, said Ross: Retrospective and prospective. Retrospective bundles "are something, at least," she said, but mirror the fee-for-service framework that is fast becoming extinct. Reporting is delayed, and it's hard to use the data to drive change within the system. Prospective bundles, she said, are more in line with the value-based models that are emerging.

PBGH's Employers Centers of Excellence Network, features a number of different programs including joint replacement, spine procedures and bariatric surgery. Part of the programs' purpose is to enhance communication between provider and patient -- helping them understand their options and obligations, so they're less likely to go doctor shopping when they get home.

Ross said that some employers, such as Lowe's, say the approach not only saves money on per-unit cost, but gets the entire team to think about costs in a different way.

[Also: Mandatory bundled payment program drains hospitals with complex patients, study says]

The average patient, meanwhile, saves an average of more than $3,000 per surgery, she said.

Prospective bundled payments from ECEN resulted in a 6 percent reductions in readmissions within 30 days compared to a typical carrier, the statistics showed, along with an almost 9 percent reduction in discharge to a skilled nursing facility.

Twitter: @JELagasse