1. Packages Episodes Bundles OH MY!
Deb Lauricia, Senior Director
Strategic Initiatives, Revenue Cycle
February 16, 2017

2. Agenda Who we are History of bundling at Cleveland Clinic
Current initiatives
International arena
Challenges
Where we are headed

3. Since 1921 A Unique Model of Care
Four doctors share a vision
Non-profit, physician-led group practice
Collaboration across disciplines
All physicians are salaried
Patient-centered mission
FRANK E. BUNTS, MD
JOHN PHILLIPS, MD
GEORGE CRILE SR., MD
WILLIAM E. LOWER, MD

4. Cleveland Clinic Today
49,000 caregivers
6.6 million total visits
164,000 hospital admissions
3,400 physicians & scientists
1,888 residents & fellows
Fast Facts
Figures as of 7/2012

5. 2016 Cleveland Clinic U.S.News & World Report
#1 in Cardiology & Heart Surgery; 22nd consecutive year
9 specialties ranked in top 3
Ranked in 14 specialties
Cleveland Clinic Children’s ranked in 9 pediatric specialties

6. Bundling Specialty Medical Care Program
Began 20 years ago as means to drive volume and provide predictable pricing
Includes both the professional and technical services for a single encounter
High end inpatient
Small provider networks and large payers

7. Bundling Program for Advanced Medical Care
Expanded to include additional procedures and chronic conditions
Broad based commercial contract offering
Local Employers
Limited outpatient

8. Episodes Transplants Includes pro and tech
Multiple payment methodologies
Phases
Flat rates
Fee for service up to maximum reimbursement

9. Episodes Time Based Fixed period of time All related services
Pro, tech, ancillary, etc
Single rate, single authorization
Direct to Employer business

10. Episodes Clinical Based Defined clinical pathway Retrospective
Medicare BPCI
Cardiac Rehab
Comprehensive Joint Replacement CJR
Ohio Medicaid State Innovation Models

11. Population Health Patient Centered Medical Home (PCMH)
Medicare Accountable Care Organization (ACO)
Comprehensive Primary Care Plus (CPC+)
Package additional services into standard care
IE: Chonic care management, outreach, etc.

12. International DRG based bundles Other services percent of charge
Self pay, Embassy, International Payers
Moving to clinical based

13. Challenges Patient Identification Registration issues
Manual claims process
Partnering with vendor for automation
Payment reconciliation
Small volumes
292 cases / $21.5M

14. Future State Clinical Guarantees CPC+ Management
Expansion of clinical bundles to commercial business
Prospective
Specialty Bundles: TAVR
Employee Health Plan Pilots
Gain Sharing

15. Take Aways Find what you do well and start there
Map your clinical process
Prepare for data, a lot
Insource vs Outsource
Patient identification is critical
Build a strong front end, lock it down
Resource for a manual billing flow
Technology is advancing
Create a process to handle the outliers
Reconcile, reconcile, reconcile