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Bundled Payments

Under HOPCo management, practices are successful at achieving significant savings implementing bundled pricing with government and private payors. Our model continues to achieve reduced readmissions rates, an increase in discharge to home after orthopedic surgery combined with a decrease in discharge to SNF, and lower lengths of stay and complication rates. Here’s how we do it.

The HOPCo advantage

At HOPCo, we have extensive experience working with surgeons, health systems, payors and other continuum stakeholders to implement successful bundled payment programs. Through our years of experience, we have built a turnkey model and approach for bundled payments – a model that can be implemented within your practice or health system. The three key components of our model include data analysis, stakeholder alignment and care redesign.

  • Data Analysis: We utilize outcomes metrics, payor data sets and claims analytics to develop a customized and cost-effective, high-quality bundled payment program that reduces the total episode cost. Since many of these metrics are significantly delayed, we have developed a thorough set of leading indicators that are reviewed with all key stakeholders on a monthly basis that enables constant adjustments and improvement – before results from the payor are known.
  • Care Redesign: Our evidence-based protocols are tailored for the bundled care model and, when implemented, reduce variation and cost, and create a sustainable model across the care continuum. Our pathways and information systems assist providers in identifying patients who may fall out of the expected cost range due to one or more co-morbidities and guide physicians to modify care or treatment to ensure the best possible outcome for the patient.
  • Stakeholder Alignment: It is essential to align your structure and strategy to achieve success for bundled pricing. Our platform enhances the alignment of all members of the healthcare team so the power of the care pathways can be fully realized. This results in providers, hospitals, post acute organizations, and others working more closely to achieve the ultimate goals of the bundles.

Our results

Our providers and hospital partners experience significant savings while improving quality after implementing the HOPCo bundled payment model. These results include an increase in discharge to home after orthopedic surgery combined with reduced readmissions rates, and lower lengths of stay and complication rates. All of which results in significant savings for both hospitals and physician practices.

Insurance Providers

HOPCo also works with commercial payors to take risk for bundled payments. For insurance companies, we provide the opportunity to preplan the cost of orthopedic procedures for members. Insurance plans can have confidence in our model and ability to develop networks of providers who provide proven high-quality, cost efficient care and manage the care experience from beginning to end. Bundled payments can be negotiated to find the best price that meets the needs of an insurance plan’s patient population and the physicians providing care.

About bundled payments

Bundled payment models combine medical expenses from all providers into one price for the cost of treating a specific diagnosis as opposed to the more traditional fee for service model. HOPCo practices participate in the Bundled Payments for Care Initiative (BPCI) led by the Centers for Medicare and Medicaid (CMS), and will be participating in the new BPCI-Advanced program in multiple markets around the country. Our practices also participate in bundled payment models with commercial insurance companies.

Bundled payments require providers to demonstrate financial and performance accountability for a specific episode of care such as a knee replacement. Costs are bundled for the physician and hospital or outpatient treatment center to create an upfront, set fee based on expected costs for each type of episode of care.

The goal of bundled payments is to improve patient care through alternate payment models that promote better coordination and quality through a patient-centered, evidence-based approach. Hospitals and physicians must be willing to make appropriate modifications to improve cost effectiveness and quality of care in order to be successful within the bundled payment model.