HFMA Trendsetter: Tackling Bundled Payments

As a national leader in quality, safety, and patient satisfaction, Adventist Health System knew adopting bundled payment models was the right thing to do for patients. However, linking payments for the multiple services patients receive during an episode of care under a single hospital represents a dramatic shift in care delivery. When embarking on this work nearly two years ago, Adventist Health System realized it was going to need help navigating this challenge.

The multi-hospital system had some experience with bundles because one of its facilities had exposure to voluntary bundled care pilot programs, but it sought assistance to develop, implement, and design processes to help its hospitals succeed in bundled payment arrangements. That’s where their work with Premier Inc. began.

As a national healthcare improvement company, Premier offers industry-leading clinical, financial, and operational data, analytics, and consulting services. It has helped hundreds of healthcare providers build and implement effective value-based-care delivery and payment models, including bundled payments. For nearly a decade, Premier has been leading the way to help providers successfully navigate federal and commercial bundled payment programs. The company uses a multifaceted approach that taps its experience in building effective value-based payment models, fosters collaboration among diverse hospitals, and harnesses robust data to support evidence-based decision making.

Fostering collaboration

The cornerstone of Premier’s bundled payment offering is a collaborative that connects healthcare organizations of all sizes. “Many times, providers come into value-based payment arrangements without a lot of experience,” says Mark Hiller, vice president of Premier’s Bundled Payment Services. “The value of our collaborative is that organizations with limited exposure are immediately connected with others who have already been engaged in this work. You’re on a team together, where members can share leading practices and accelerate change. Support from Premier’s experts provides guidance and structure.”

Premier’s Bundled Payment Collaborative launched in 2011. Participants take part in regular meetings where they share ideas, data, and innovative practices with peer organizations. Each member has a dedicated bundled payment consultant to engage in regular, topic-centered discussions to promote success, including performance results, care redesign strategies, how to create effective post-acute care networks, bundled payment program requirements, developing aligned provider incentives and gain-sharing arrangements, among others.

Collaborative participation is tailored based on unique member needs. “For example, if several organizations are tackling a similar issue, we’ll bring them together to compare notes and discuss improvement ideas,” Hiller says. “The participating organizations drive the discussions, and we provide subject matter expertise.” Participants also have access to an online community that provides insights on new policies, as well as tools and various templates.

Adventist Health System has found its participation to be worthwhile. “Probably the biggest benefit is the overall knowledge we’ve gained,” says Patricia Fennell, Adventist Health System’s director of clinical quality improvement. “We weren’t sure where to begin with implementing bundles across multiple hospitals. By connecting with peer organizations via the collaborative, we were able to learn from others’ experiences, identify leading practices, and avoid pitfalls. We knew we needed different solutions tailored to each of our facilities—as one size does not fit all—and we were able to glean what could effectively work at each institution.”

One collaborative best practice Adventist Health System leveraged is the value of obtaining commitment statements from patients. “We had patients sign documents committing to their health,” Fennell says. “The patients agreed to follow directions for pre-operative and post-operative care, and communicate with the hospital if issues arose. Based on input from our collaborative colleagues, we developed a patient commitment statement, which has been scaled across our system.”

Pre-operative education was a focus area for Adventist Health System. “We ensured all of our sites implemented a pre-operative joint class, which outlined what to expect before, during, and after surgery,” Fennell explained. In this class, staff talked with patients about what to eat and how to exercise to strengthen their joints before and after the operation. They also discussed the need to refrain from smoking and taught them about how to keep surgical site areas clean. “We gleaned ideas for content and logistics through the collaborative about how to best educate patients on how they can heal better and faster,” Fennell added.

Adventist Health System also learned the value of having navigators guide patients throughout the care experience. “Our navigators meet patients at the pre-op class and help them through every phase of care—staying in contact with patients during the 90 days post-discharge,” Fennell says. “They serve as the patient’s sole point of contact if an individual has any questions or concerns after being discharged.”

Enabling data-driven decisions and benchmarking

In addition to facilitating the collaborative, Premier offers a data analytics tool designed to help users easily collect actionable insights from their bundled payment initiatives. “From the beginning, we wanted our members to leverage each other’s learnings but ensure learnings were supported by data,” says Premier’s Hiller. “Our tool focuses primarily on Medicare claims data, which can be challenging for providers to navigate on their own.”

Members use the analytics tool to understand what’s happening across provider systems and care episodes, and drill down to the physician and patient level—examining individual claims to identify big cost drivers. Additionally, they know what care and services the patient is receiving outside of their facilities, which is a game-changer.

“The data analytics tool has been extremely useful,” Fennell says. “Although CMS has a portal through which you can examine claims data, it is difficult to maneuver and understand. Premier’s tool grabs our claims information and streamlines the data through an intuitive interface, where we can easily review our data and understand where we may have opportunities. For example, we might notice variations in how physicians utilize post-acute care services. This allows us to work with our physicians to identify best practices and share them across our system.”

Using the analytics tool, members can also compare their performance with their peers’. “The benefit of using one data analytics solution within the group is that organizations can leverage data benchmarking reports to help them determine how they stack up against top performers,” Hiller says. “In turn, conversations can be had with those high-performers about how they’ve achieved success. It streamlines and accelerates the improvement process so organizations achieve their goals faster.”

Leading practices yield better outcomes

Adventist Health System has generated positive results within their bundles. “We’ve noticed an improvement in patient satisfaction,” Fennell says. “We are really helping patients make the transition to the next stage of care. They truly appreciate having someone to call and help them understand the transitions in the care and healing process.”

The health system has also decreased the number of patients entering skilled nursing facilities post-operatively. “With the emphasis on preparatory education, most patients are strong and healthy enough to go home right after surgery instead of transitioning into a post-acute facility,” Fennell says. “Even patients who require post-acute care are not staying as long in these facilities compared to previous years. We’re getting people back to their own environments, where they’re comfortable and can heal faster, which simultaneously improves patient satisfaction and also reduces costs.”

It takes a multifaceted approach

Large-scale healthcare transformation is not easy, but it is possible when healthcare providers are solving problems together by providing access to effective tools, resources, and services. By offering a dynamic collaborative led by seasoned experts and the ability to seamlessly make evidence-based decisions with user-friendly analytics, Premier is helping healthcare organizations successfully navigate bundled payment initiatives in today’s value-based care environment.