Bundled payments of surgical services has been slow to take hold with private insurers. However, as detailed in Modern Healthcare, bundling platform Carrum Health will offer its’ preferred network of providers to State employees in both Maine and Connecticut. The plan in Maine covers 100 procedures and requires no co-pay or deductible within the Carrum network – which includes New England Baptist Hospital in Boston and Connecticut Joint Replacement Institute in Hartford. Carrum (see their press release on the Maine agreement here) also offers hospital options around the country.
Carrum CEO Sach Jain is quoted in Modern Healthcare saying that “self-insured employers whose plan enrollees use Carrum’s network typically pay 35% less than they would otherwise pay for the service. Eligibility, payment arrangements, and other logistics are streamlined through Carrum’s cloud-based platform.” The program defines bundles similarly to CMS’ Bundled Payment for Care Improvement Advanced program.
EHC NOTE: While a bit slow to catch hold, bundling or directing patients to centers of excellence seems to be increasing bit by bit among private insurers. We’ve previously discussed Walmart directing employees requiring total joint replacements to centers of excellence with better outcomes at a lower cost. The rationale for directing patients to high volume centers of excellence at a lower cost seems compelling for any insurer (whether commercial or a self-insured employer). The clear implication of this trend is that if a facility does not qualify as a center of excellence (on both cost and outcomes) for some procedures that they will suffer leakage of surgical volume to facilities that do qualify.
As we concluded in the Walmart article, the question for facilities competing with such centers of excellence is how do they level the playing field? In our experience, facilities of almost any size can compete in specific specialties in their local markets by focusing efforts on a certain set of procedures and devoting resources to optimize cost, quality and outcomes. All stakeholders involved in the procedures must be integrated, and current protocols must be used – such as the Perioperative Surgical Home, minimally invasive surgical techniques when appropriate, advanced pain control techniques and concepts of ERAS. Our advice: create partnerships with local businesses or payers using your track record as a key differentiator. While you may not be able to partner with the largest employer in the country, smaller, local partnerships can be profitable for facilities and beneficial to your communities.