Page 33 - Hoag Orthopedic Institute 2014 Outcomes Report

“THE KEY TO OUR SUCCESSFUL BUNDLED PAYMENT MODEL IS ALIGNMENT BETWEEN THE HOSPITAL AND PHYSICIANS. IT FOSTERS BEST PRACTICES TO UPHOLD QUALITY CARE AND REDUCE COSTS.”
GABRIELLE WHITE, RN, CASC, EXECUTIVE DIRECTOR, AMBULATORY SERVICES & NETWORK DEVELOPMENT
MEDICAL TRAVEL PROGRAM
Nationwide, the concept of medical travel to centers of excellence continues to gain traction. The Medical Travel Program that began at HOI in 2011 has seen steady gains, particularly among patients from Northern California, Nevada, Alaska and abroad. As a Blue Distinction Center® for Specialty Care, HOI is among a select number of facilities nationwide approved by Blue Cross and Blue Shield to receive travel patients.
The HOI Travel Program is attractive to out-of- area patients and payers for several reasons:
• The Travel Program benefits patients from
areas lacking in proven-quality providers with
extensive experience in orthopedic care.
• Given that higher costs ultimately result from
lower quality care, travel to a high-quality provider such as the HOI Medical Travel Program assures value.
• The bundled rate covering all provider fees is easy for payers to manage. In rare instances
if care is required outside of the diagnostic pathway, additional charges may apply. Knowing up front the total cost of care – as opposed to the variable price tags – simplifies administrative claim work while providing cost controls.
• Because HOI contracts with all major payers, many out-of area employers can often negotiate with their insurance providers to opt
to send orthopedic patients to HOI. Research demonstrates that employers are willing to adopt tactics to help improve healthcare while managing healthcare costs, including providing richer benefits to increase use of designated facilities and narrowing networks to feature cost- effective providers.
BUNDLED PAYMENT
The nation’s healthcare tab continues to climb:
• Health care in the U.S. now accounts for 17
percent of the gross domestic product (GDP). Experts expect healthcare costs to continue increasing and top 20 percent by 2020.
• By 2040, there will be twice as many Americans older than 65 as there are today. Poor diet, physical inactivity and lack of health screening fuel the threat of population health declines.
National health policy discussions about health reform and meeting future challenges often target the adverse effects and unsustainability of fee- for-service, the predominant method of paying for healthcare services in the U.S. Fee-for-service payment has been widely criticized for financially motivating providers to focus on increasing volume of services and thus contributing to the nation’s high rate of healthcare cost growth. The fee-for-service payment system has also been faulted for contributing to fragmented care.
Bundled payment is increasingly seen as an attractive, cost-saving alternative to fee-for- service payment, particularly at high-volume facilities. A bundled payment is a fixed dollar amount covering a set of services, defined as an episode of care, for a defined period. Bundled payment models reward providers for improving the quality, efficiency and alignment of care.
Under the Patient Protection and Affordable Care Act (ACA), the secretary of the Department of Health and Human Services (HHS) is
rolling out a voluntary pilot bundling program. Additionally, in 2013 the Centers for Medicare & Medicaid Services (CMS) launched the Bundled
2014 OUTCOMES REPORT | 33