How to make bundled payments work? Start by engaging patients

Over the past two years of the mandatory comprehensive care for joint replacement payment model, Froedtert Health saved $1.5 million on the 615 patients who had the surgery, according to Mike Anderes, chief innovation and digital health officer for Froedtert and president of its affiliated Inception Health.

Froedtert, which is associated with the Medical College of Wisconsin, was among the hospitals chosen by CMS to participate, and was ready when it was notified, even though the model asks providers to take on risk for a 90-day period, Anderes said.

"We'd been working on reducing total cost and improving outcomes for years," he said. "We were excited to participate."

The 90-days began just after the procedure, when a patient is sent home, or in some cases, to a skilled nursing facility.

The new model meant trying to avoid the skilled nursing facility, being readmitted, or going to the emergency room.

Previously, patients went home with little support, Anderes said. It  used to be after a total knee replacement that patients were given a three-ring binder of information and a number to call.

"We needed a more daily protocol for the whole 90 days," Anderes said. "We went through a process to find bite-sized engagement with patients on a daily basis."

Froedtert worked with GetWellNetwork on its patient engagement platform, designed by a physician. Patients self-report data on their condition and, from that information, an early warning system can notify providers when a person needs attention -- before they seek care in the ER.

Patients are asked to look at their incision and report whether it is draining, or red. If the answer is concerning, a nurse reaches out.

Before surgery, patients were told what to expect. That they should be able to bend their knee to a certain point, for instance, that they should stop taking aspirin five days before surgery and to stock the fridge. An assessment for home health was done.

The CMS mandatory piece is now over and the system is continuing with about 15 voluntary bundles, but not for joint replacement with Medicare, according to Anderes.
This is because CMS caps what a system can earn and sets a new performance price based on past results. It would be hard for Froedtert to achieve greater results when it had already reached a level of high performance.

But what was put in place in the support of patients after surgery remains. The system showed that the value-based goal of reducing post-acute care and readmissions is achievable.

Anderes will discuss how to reduce readmission rates and ER care, as well as how to elevate consumer satisfaction at HIMSS19 in "Patient engagement as a key to bundled payment model success," from 1-2 p.m., Wednesday, Feb. 13, Room W315A.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com