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

2. 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

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

4. Episode Spending Example
DRG 470

5. 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

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

7. 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

8. 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

9. 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

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

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