October 04, 2016
4 Key Efficiency Strategies to Make the Most of Bundled Payments

Bundled payments combine all related treatments or procedures into a single episode of care — a bundle, if you will. The goal is to reduce unnecessary costs or preventable complications, thereby improving care quality and freeing up resources to keep healthcare sustainable. The lump-sum amount for each episode of care often comes with monetary incentives to reward resourcefulness and train against excesses that drive up costs.

Although bundled payments currently make up only 2% of value-based contracts, there has been a decided shift toward value-based systems of care. Maximizing bundled payments requires careful planning that can account for multiple treatment factors, provider types and varying patient needs. Here are four efficiency strategies to pursue.

1. Reduce duplicative care

Tests, examinations and procedures that have already been performed, but were repeated because of a lack of communication between providers, is not only counterintuitive from a financial perspective, but also a waste of precious time and money that could be better spent on progressing patient care to the next level. To prevent duplicative care, clinician-to-clinician communication needs to be improved — particularly between primary care providers and specialists, as well as acute care and post-acute care providers — concerning patient history and current health status. Clear documentation in patient health records, of exactly what has been done to treat the patient and when it took place, provides a strong, accurate foundation on which to base future and ongoing care. And, done correctly, it can serve as a dependable resource that opens lines of communication between different healthcare providers.

2. Improve information exchange

Opening those lines of communication is essential to the next step: true collaboration. First, you’ll need to view patient care as a team effort that requires many people to coordinate many moving parts within the acute hospital setting, during the transition to the post-acute phase, and then in primary care.

Data management capabilities and reliability of information make this coordination possible, but electronic health record (EHR) interoperability lies at the core of collaborative care. Even the best patient documentation in the world won’t get used if no one can easily access it. In addition to ensuring your EHR system works with those of other providers, sharing claims data with other providers can help them better understand how costs are calculated so that they can more actively determine how to reduce excesses in their own practices.

Sharing data and patient documentation can help providers further collaborate by developing clinical pathways — which involves setting standards and efficient, effective paths of care, while helping payors understand how much and what exactly is involved in the entire process. Efforts such as this don’t just benefit the patient, but give providers more leverage with payors at the negotiation table. In this way, bundled payments can be more accurately determined, leading to greater success in staying within limits while reaping rewards.

3. Standardize practice by eliminating unwarranted variation

Some may argue that placing too many protocols into a system or standardizing medical treatment can be restrictive in a line of work that often dynamically or unexpectedly changes according to the patient’s current condition. And that’s true. The key is to distinguish between ‘good’ variation and ‘bad’ variation. Rooting out unwarranted variation helps systems focus on the essentials first, and then systematically improve upon them with more specific detail later, according to need. Having a standardized foundation for practice removes repeated microdecisions for routine parts of care, opening space for creativity and medical expertise to be applied when the not-so-routine arises.

4. Prevent complications

Often, complications arise not due to a failure in acute care, but due to a lack of communication and coordination between providers, or between hospital and provider, or between a hospital and another type of facility. The accurate, thorough documentation produced by medical scribes is a crucial communication connection between acute and post-acute care that helps post-acute providers gain a clear understanding of the history and current state of the patient. Furthermore, using medical scribes in the outpatient setting can help speed and strengthen data integration, letting providers more effectively chart the progression of and manage the patient’s health condition.

Patients should also be included in managing their own care, and their preparation and education is key to preventing unnecessary complications and readmissions. Providers and facilities should also take steps to include families and carers when developing well-defined goals for post-hospital care or ongoing management. Patients and their families/carers should be provided with clear instructions, education about their condition, and what signs do — and do not — require a hospital visit. In addition, the onus is on the provider or facility to follow up with high-risk patients, to help ensure they are not experiencing minor complications that could become serious.