Clinical Care Bundles: Who s Selling? Who s Buying? Who Cares?

Transcription

1 Clinical Care Bundles: Who s Selling? Who s Buying? Who Cares? Michael G Glenn, MD June 7, 2018

2 The VMMC Quality Equation Q = A (O + S) Q: Quality A: Appropriateness O: Outcomes S: Service W: Waste W

3 Is there really a market for quality? 3

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5 Save Money. Live Better Virginia Mason 5

6 Walmart insights: Variation as a driver of unnecessary cost 1.Pricing 2.Utilization of tests and procedures 3.Complication rate 4.Return to work 6

7 Walmart Playbook Create short list of providers Outcomes Surgical experience Location On-site interviews prior to final selections Validation of outcomes data provided Assess capacity to deliver service Bundled payment model TPA contract to administer bundle 7

8 Deliverables for the Walmart Benefit design: create incentives No out of pocket medical costs for member Travel, food & lodging for patient and care companion Communicate advantage of bundle to members 8

9 Deliverables for the TPA Direct patients to most appropriate COE provider Coordinate logistics & concierge services Validate data related to patient experience Pay provider for bundled claim 9

10 Deliverables for the provider Alignment with Bree clinical quality standards Appropriateness Fitness for surgery Best-practice surgery Rapid return to function Measure outcomes Implement processes to deliver reliability Defined handoff to home PCP Defined follow-up with patient 10

11 Reporting quarterly quality metrics Appropriateness Patient-reported disability Evidence-based surgery Medicare safety measures Rapid return to function Patient-reported disability Patient experience Medicare standard survey Affordability Readmission rate 2014 Virginia Mason 11

12 Single standard of care 12

13 Orthopedics: breakthrough bundle of care 13

14 Health Care Authority Purchases health care for over 2.2 million people through Medicaid (Apple Health) and Public Employees Benefits Board (PEBB) Program $10 billion annual spend Large network overlap between both programs Value-based purchasing mandate 2021 Goal: 90 percent of state-financed health care and 50% of commercial health care will be in value-based payment arrangements 14

15 Considerations Quality Member Experience Cost 615 procedures done on our members in 2013, HCA/PEB paid out nearly $18m in hospital claims plus approximately $1.3m in additional costs within 90 days post procedure Virginia Mason 15

16 Overview: Center of Excellence (COE) for Total Joint Replacement 2016 procurement for COE Virginia Mason Medical Center Aligned with Bree Criteria Highly integrated, with CQI processes Team approach with MD leadership Bundle includes Pre-surgery visit and testing Surgery and anesthesiology Hospital stay and inpatient rehab Parking, transportation and lodging for member and caregiver 90 day warranty Little to no out-of-pocket for member 16

17 Bundle Care at Virginia Mason Focus on clinical appropriateness criteria: Evidence-based, appropriate, and surgical avoidance Controlled and predictable costs: Remove variability while providing competitive rates Volume: Reward high quality provider with driven volume Comprehensive: From patient engagement through return to function Demonstrated metrics: Quality and satisfaction Warranty: Accountability for avoidable readmissions 10

18 Warranty No additional payment for avoidable readmissions 1. Seven-day window of accountability a.acute myocardial infarction b.pneumonia c.sepsis 2. Thirty-day window of accountability a.surgical site bleeding b.wound infection c.pulmonary embolism 3. Ninety-day window of accountability a. Mechanical complication related to surgery b. Infection of implant 18

19 Travel Policy Paid round trip flights for eligible members and their care companion Town car transports from airport to hotel and back to airport when member is discharged to return home Mileage reimbursement at current IRS rates Lodging (meals excluded) Parking (at hotel/hospital and airport) Prepared travel cost analysis Based on utilization and means of travel assumptions. 19

20 State of Washington - VM total joint bundle 1. Savings for purchaser and individual 10-15% savings for State $1000/episode for individual 2. Improved finances for VM Substantial increase in new patients to VM 3. High patient satisfaction 100% would recommend 20

21 Surgical Bundles - Pros Enhancement of value Disruption in highly consolidated markets Predictability for patient and employer 21

22 Surgical Bundles - Cons Travel requirement for patients Disruption of primary care relationship Set-up for price squeeze Lack of TPA expertise in most markets 22

23 Bundles Current State Robust proof of concept Need aggressive benefit design to steer volumes from traditional paths Considerable opportunity for more 23

24 Surgical Bundles Barriers to Spread Inefficient markets Unmotivated potential buyers Relative lack of capable integrated providers with robust systemness 24

25 Thank you 25