One health system’s bundled payment journey

Traditionally, Medicare has made separate payments to providers for every service a patient has had during the course of his or her treatment. As with all things, however, times change, and this approach resulted in fragmented care coordination across the continuum for the patient and at a tremendous cost to healthcare providers. To help ensure accountability, the Center for Medicare and Medicaid Innovation (Innovation Center) developed an initiative called the Bundled Payments for Care Improvements Initiative (BPCI) to test the waters in regard to a payment model that helped reduce costs while improving the quality of care for patients. To implement this plan, healthcare providers had to figure out how to strategically implement and align all their business practices across physicians (both internal and external) and all post-acute providers. This paper describes how Virtua implemented new care redesigns and clinical pathways, assessed what resources it had internally and which ones it needed to outsource, how to get buy-in from the physicians, ensure post-acute collaboration and be able to assess all these new processes in order to make any changes going forward. Virtua successfully achieved 15 per cent under CMS target pricing, while maintaining high quality outcomes, with the initial CMS BPCI programme for total joints. Virtua will use these learnings to go further with the new bundled payment model.