Five Ways Bundled Payments are Driving Innovations in Care Delivery

Today’s payment environment is creating new ways for providers to treat patients and keep them healthy. Contrary to the traditional volume-based, fee-for-service payment system, value-based payment models, such as shared savings, bundled payments and other alternative payment models (APMs), incent healthcare providers to improve the quality of care and health status of the communities they serve. Participation in these models is growing at a rapid pace, with thousands of health systems and physician practices joining value-based care initiatives across the public and private sectors.

Bundled payments can help providers leverage greater financial incentives to improve care delivery practices.

Bundled payments, specifically, have a long, diverse history, going back to the 1980s. Through numerous tests of change, research has shown that creating financial incentives for care across an episode is an effective strategy for improving outcomes, enhancing care coordination and aligning providers behind shared performance improvement goals.

Bundled payment models are helping providers:

• Standardize care guidelines and post-discharge procedures, hardwiring them into every clinical interaction by incorporating these guidelines and order sets into their electronic medical records.
• Better manage post-acute utilization, which presents major savings opportunities.
• Improve patient outcomes due to the cross-continuum nature of most bundled payment episodes. Organizations can increase their focus on assessing and redesigning care across episodes (i.e., find and close care gaps) and execute continuous improvement processes to achieve both low-cost and high-quality outcomes.

Cross-continuum care transformation is also one of the cornerstones of bundled payment models, such as ensuring patient transitions to post-acute or community settings go smoothly. Just as the benefits of implementing bundled payments on clinical care delivery have been documented, the specific innovations, successes and impacts to care delivery work have been astounding and are noteworthy.

Hospital and health system members of Premier’s Bundled Payment Collaborative have shared numerous innovations that are allowing them to better support their patients. These innovations have driven significant cost savings and quality improvements, and helped members secure the capabilities and partnerships needed for future economic and competitive viability.

Premier^® members are renewing their focus on patient optimization, coordination and communication between all care providers.

With renewed interest in telehealth services, the use of patient home monitoring and phone apps for encouraging patient engagement, as well as tablets for post-discharge follow up and communication are now more common to aid in ensuring smoother transitions from the acute care setting to the home. Additionally, implementing discharge classes for patients and families that provide information and guidance on the expectations regarding the discharge process, have become common practice following inpatient surgery. But there are some more creative initiatives happening in Premier member communities.

Premier members are leveraging community resources to innovate the care experience by:

• Partnering with Uber, Lyft and other transportation companies to ensure patients make it to follow-up appointments, which has reduced readmissions at several locations.
• Offering meal programs for patients who frequent the emergency department (ED).
• Embedding social workers and behavioral health resources in primary care offices and the ED to assist patients with mental health issues.
• Implementing a traveling care coordinator program for shut-in patients and/or patients who do not have a home base.
• Creating community outreach programs that use community EMTs for patient follow-up post-discharge and as a first line of triage to help reduce non-emergent emergency room visits.

Effective patient transitions require a deep evaluation of care management, care coordination and discharge planning resources, roles and job descriptions. It involves change management and thinking differently about care boundaries, understanding social determinants that impact frequent ED visits and creating strategies to address the specific needs of each patient cohort.

Efforts to transform care are not easy, but movement toward creating seamless, patient-centered care delivery is happening. Bundled payment models are helping to move the needle. To learn more about the capabilities needed to build successful bundled payment models, check out Premier’s white paper, Ready, Risk, Reward: Keys to Success in Bundled Payments.