Geisinger lauds benefits of bundles

The reviews across various sectors of the healthcare industry are mixed for the bundled payment model, but Geisinger Health System gives the model five stars.

Healthcare Finance News talked to Kevin Brennan, Geisinger’s executive vice president and CFO, about the advantages the health system has seen by adopting the bundled payment model.

[See also: Providers tepid on bundles]

Q: Geisinger was one of the first health systems to take on bundled payments, a model many providers are nervous about – what have been the biggest benefits of it to your system?

A: You have to go back in a sense when you talk about the benefits – what were we trying to do? There’s lots of clinical data to suggest that not everybody receives best practices when they show up at an organization. We were trying to change that.

The real benefit that we have realized is being able to take all those complicated clinical processes and imbed them into clinical workflows. That type of standardization and that type of promoting quality ends up standardizing workflows; now one can readily identify a misstep in the workflow.

It actively engages patients in the care process. Let me give an example, for someone eligible for the coronary bypass bundle, in pre-surgery there would be an actual contract entered into with the patient to do things differently – it creates an activation. If they have bad eating habits they would have to agree to make some healthy eating changes.

[See also: Payers and employers unmoved by bundles ]

These types of activities have benefited the organization and have a wider impact on population. (They’re) particularly beneficial to us when the patient is a member of our health plan.

These benefits have promoted better standardization, better quality and better relationships of providers – in this case hospitals with physicians. It strengthens a clinical collaboration. In the case of after-care it could even go as far as rehab providers; it might involve home health or nursing homes. There’s a chance for a greater type of clinical collaboration, for greater clinical referrals and standardization of evidence-based practices.

It has resulted in better outcomes at lower cost. You have to imbed the best practices into everyday workflows – it is a naturally reinforcing mechanism to ensure the best practices are carried out each and every time. Pretty soon everyone who comes through benefits.

What have been the biggest challenges of implementing bundled payments?

A: It takes a while, it’s not you wake up one day, get a new director, flip a switch, and you do it. It’s very carefully planned. There are lots of moving parts. The whole activation of patient engagement requires careful thought to the contracts; there are financial considerations. … You need clinical champions. It takes clinical leadership to step up and say we can be as good as we are.

When we first started, we had great results but we knew we could do even better. Then it spread to other specialties, and now we are at the point where it is of interest to other health systems. Accountable care was the buzzword – and while other organizations may not have been ready to take responsibility for the entire care of the patient, they wanted to get their feet wet and explore bundled care – they just didn’t know how to do it – they need help – they need our intellectual property. Many organizations asked us and paid us to help to do the same.

Right now, after many years of negotiations with CMS, we are the convener group for 15 organizations who are about to embark on bundled payments using our ProvenCare system – we are seeing the financial benefits.

Q: How is the ProvenCare system impacted by the spreading of bundled payments at other health systems?

A: I am not underestimating that someone in our neighborhood could try to do it better than us, but we are not worried about that. Many organizations are staying in fee-for-service as long as there aren’t penalties. Who is going to take on that kind of investment and the political fall out? We are not worried that we might create another expert – we think it’s good and we are enjoying our recognition. We are getting some financial benefits.

Q: What does the future of bundled payments look like at Geisinger?

A: I think it’s very bright. I think it is a concept here to stay. I think back into the 1980s when Medicare started its DRG system – that was always the hope that the diagnostic groups would promote winners and losers. I think by virtue of the number of folks coming to us, and the number of folks interested in being responsible for the care but not ready for full capitation, that it is still the hope.

[See also: Bundled payments feasibility tested]