Driving Success in Bundle Payments Presentation by Kelly Benson, RN Director of Community Care Mgmt. April 5, 2019

Session Objectives Define episode-based care reimbursement Outline strategies to impact care in bundled payment initiatives. Demonstrate why outcomes become such an important metric in bundled payment

What is a Bundled payment? A single payment to a provider for all services associated with a treatment or condition during a defined episode.

Episode Spending Example DRG 470

Payment Shift from Quantity to Quality Traditional Medicare Fee for Service Fragmented care Minimal coordination across providers or settings Rewards quantity vs quality Bundled payment Provider assumes risk; can profit if cost of care is below bundled payment or lose money if above bundled payment Often linked to meeting certain quality measures to ensure delivery of high-quality care is maintained

Bundle Clinical Care Re-Design Reduce Practice Variation Standardize Pathways Engage Physicians Enhanced Care Navigation Avoid Readmissions

Reduce Variation & Standardize Pathway’s Culture Standardize Order Sets Think Lean Process Remove Silo’s from Hospital and Post-Acute Care Create Best Practice Clinical Pathways EMR Create a Standardize Process for Follow-up Ability to identify the bundle patients Ability to chart in EMR after discharge Ability to pull measures for scorecards

Physician Engagement Identify Develop Deploy Turn physicians into partners – engage them in the care transformation process. Physicians seen as leaders based on the care they provide Have strong positive relationships Identify Educate about the goals Provide Support Develop Educate peers Spread a positive message Navigate barriers Deploy

Enhance Care Navigation / Avoid Readmissions Bundle Buster Every Time! Provide Pre-op education, if possible Risk screening on admission Targeted intervention(s) for high risk patients Appointments made before discharge Follow up phone calls Post Acute Care performance improvement teams Automated readmission notification EMR

Example Metrics for Post-Acute Agencies Length of Stay Average Cost Readmission Rate Complication Rate Patient Satisfaction Mortality Rate

Director of Community Care Management THANK YOU! Kelly Benson, RN Director of Community Care Management Baptist Health