1. One Approach to Bundled Payments
Package Pricing
One Approach to Bundled Payments

2. Package Pricing: Overview
The purpose of this presentation is to share the process that the Cardiac Package Price team followed to ensure a successful product. Depending on your product, there may be variations to this process. This is intended as a guide. This is a working document that should be updated by future teams to reflect your own unique experience as you progress through the process so that all projects to follow can benefit from our learnings.

3. Package Pricing
Team Charter The Team Charter is a document to create during the project kick off. It helps bring the team together on the purpose of the project, the scope, the team members and their role, and lays some of the ground rules. Driver Diagram The Driver Diagram provides the Aim, the primary drivers, and the secondary drivers that help you focus on those items that will provide you success. Initially, this document was used a lot to keep us focused on the end goal. Eventually, this document is only referred to when there is confusion or we needed clarity.

4. Package Pricing: Assumptions
There were several assumptions that we made early on. These proved to be accurate, and did serve as a reminder that we needed to encourage some of these assumptions in order for them to become reality. Requires a team to execute – individually we did not have the expertise to succeed. We relied on each team member to attend meetings fully engaged, to make progress outside of the team meetings, and to work collaboratively and patiently as we learned along the way. Ongoing review and feedback with providers to ensure their buy-in with each deliverable. We decided early on that we could not work in a Bellin vacuum. It was essential for us to continually bounce ideas, thoughts, and strategies off of the provider and key stakeholders to ensure that Bellin’s final package priced product was going to be a product that the everyone was excited about.

5. Package Pricing: Define Customers and Determine Products
These are the process steps that the Cardiac Package Price team developed. We encourage you to add details as your team learns.
1. Define Customers Employer vs General Public vs Population/Broker/ Insurance Company based on the demographics of a targeted population
Get statistics on health of identified population (get assistance from decision support and business health solutions)
Select Pilot customer
2. Determine Products based on specifications in the Driver Diagram secondary drivers
Example: Product 1 = Heart cath. Product 2 = Imaging Package
per member, per month package for managing coronary heart disease for a population
Define all components of product across the continuum (across all 5 views of the production system)

6. Package Pricing: Determine Provider Services and Compensation Structure
Identify all physicians/providers who participate in the delivery of the product
Evaluate status of each (Employed vs. Independent)
For those that are Independent negotiate professional fees, and partner with legal services to draft a contract for payment
Operationalize compensation for Independent parties
For employed physicians, regular RVU/compensation built in contract will follow

7. Package Pricing: Patient Experience
4. Identify and Determine Patient Experience
Create a detailed Product/Patient Process flow
Identify best practice guidelines
Create Patient Compact
Review Patient Experience with the Customer
Identify patient experience manager for the pilot
Review with providers and obtain their feedback

8. Package Pricing: Clinical Pathways
5. Identify and Determine Best Clinical Pathway for the Patient
Determine process and outcome measures
Ensure EHR is leveraged to support clinical outcomes by designing workflows that support clinical protocols
Review Quality measures with the customer
Identify quality control manager for the pilot
Ensure patient compact is executed during pilot with patient engagement
Review and maintain current patient education materials
Consider what type (if any) guarantee is needed post procedure
Review with providers and obtain their feedback

9. Package Pricing: Efficiency
6. Maximize Efficiency and Create Lowest Cost Platform for Care
Streamline the supply usage to minimize medical supply costs
Ensure no unnecessary waits and delays built into the process
Ensure all efforts are in place to prevent any clinical complications
Manage variation in clinical practice

10. Package Pricing: Determine Price
7. Determine Pricing
Get input from the Revenue Cycle Management Team
Review a sampling of current charges and payments by product and payer types
Identify all revenue codes and CPT codes that is in scope as part of the package price.
Compare current pricing to best in market
Be sure to look at the Average Net Revenue compared to HMO/PPO to what the customer is currently paying
Revenue cycle representative partners with CFO to determine appropriate level of discounting
Partner with Employer Health solutions in engaging the broker if appropriate
Present proposed pricing to customer for feedback
For products which involve independent providers, consider professional fees in price
Determine final pricing
Present proposal to customer

11. Package Pricing: Determine IT Supports and Pilot
8. Determine IT/Decision Support requirements
Meet with IT to create project request/estimate
Meet with IT to finalize needs
Build minimal Epic pilot as needed
Meet with DS to finalize reporting needs
Build minimal reports
9. Execute the Pilot based on Specifications
Engage stakeholders (i.e. physicians & various departments that these patients will be flowing through)

12. Package Pricing: Evaluate, Spread,and Improve
10. Evaluate the Pilot based on Specifications
Improve the process as needed
11. Spread to other Employers/Customers/Products
Based on pilot results and market demand, spread the package price to other areas of the business.
12. Continually Improve
Keep current on changes in evidence based practice – modify clinical pathway as needed

13. Package Pricing: Driver Diagram