By Rick Norling
Retired CEO Premier healthcare alliance
Innovative efforts at Geisinger Health System to re-engineer care have led to an exciting concept called acute care bundling.
The boundaries of acute care have typically been admission and discharge processes at hospitals. However, the opportunity for process improvement and the elimination of waste multiply substantially when acute care is redefined beginning in the doctor’s office when the need for an acute intervention is identified. It concludes post-discharge when the patient has hopefully achieved a strong functional outcome.
Insurers have sophisticated claims databases which allow for understanding all services rendered during an acute episode and the costs related to those services.
There is significant variation in the total cost of an acute episode related to appropriateness of service, errors and complications, variation in provider practice and patient compliance among others.
Incentives in the form of bundling payments for all services and reward sharing with providers have proven to substantially reduce the total cost of that episode.
The reward sharing incentive can align both the economic and quality interests of all parties involved. It provides for a much enhanced patient experience and outcome.
It’s a simple yet elegant idea that should appeal to all concerned.
November 14th, 2009 at 10:40 am
We all know how rapidly the DRG system changed how health care was delivered when it was first implemented. Bundeled care is the next natural evolution. Taking a macro approach rather than trying a top down micro management of how care is delivered needs to be a top priority in reform.
November 16th, 2009 at 1:05 pm
I agree and I believe this would promote the development of integrated systems, which you need to achieve a well rounded healthcare delivery system. Incentives for both efficient, cost effective delivery and measurable QUALITY outcomes.
November 20th, 2009 at 8:11 pm
Bundling provider payments to promote a common and consistent approach to patient treatment is simply a sound economic principle. If an economist or business executive were asked to design a healthcare delivery system, sharing a common incentive for performance would be a given. Health care in this country still suffers from the vestiges of being the the remaining industry that still retains elements of the guild mentality that in many respects accounts for our continuing classification as a ” cottage industry.”