Bundled payments pave the way

April 15, 2011

CaroMont Health, based in Gastonia, NC, and Blue Cross and Blue Shield of North Carolina (BCBSNC) have announced a collaborative arrangement to offer patients a new health care delivery and reimbursement model for knee replacements.

CaroMont Health, based in Gastonia, NC, and Blue Cross and Blue Shield of North Carolina (BCBSNC) have announced a collaborative arrangement to offer patients a new health care delivery and reimbursement model for knee replacements. The bundled payment arrangement is based on the PROMETHEUS Payment model and will cover the entire knee replacement, including the pre-surgical period of 30 days prior to hospitalization, the surgery itself, and most follow-up care within 180 days after discharge from the hospital.

This program is part of CaroMont Health’s move to become an accountable care organization. The strategy includes partnering with local employers and payers to institute cost-effective initiatives that cover both hospital and physician services for a full episode of care.

“Critical components of accountable care include new approaches to facilitate coordination, efficiency and productivity; reimbursement models that reward improved quality outcomes; and health information exchanges to enable communication across provider sites. These components can all be found within CaroMont’s bundled payment program,” says Valinda Rutledge, president and CEO of CaroMont Health.

She says she this initial program is likely to lead to other collaborative opportunities, including the possibility of redesigning entire episode of care programs for chronic diseases.

To successfully launch this initiative, CaroMont Health partnered with GE Healthcare and Sg2 analytic experts to assess the cost of a full knee replacement episode of care, including the pre-surgical period, surgery and post-surgical period. This analysis included observations and interviews with members of the CaroMont Health clinical staff to redesign the care pathway and quantify the financial impact of the redesign through simulation modeling recently developed by GE Healthcare for this program.

Physician practices participating in the program include Carolina Orthopaedic and Sports Medicine Center, P.A. and Gaston Anesthesia and Pain Management Associates.

The bundled payment arrangement does not apply to federal employees covered by BCBSNC or to customers with BCBSNC Medicare plans.