In today's evolving healthcare landscape, optimizing payment processes and enhancing financial performance are vital for the success of independent medical practices. This case study explores the successful collaboration between the Center for Sports Medicine & Orthopaedics (CSMO) and HealthMe, a leading healthcare payments solution provider. By implementing innovative strategies and leveraging advanced technologies, CSMO aimed to streamline payment processes, improve revenue management, and deliver an exceptional patient experience.
Established in 1979, CSMO has been a trusted provider of comprehensive orthopedic care in Chattanooga, Tennessee. With a mission to deliver exceptional orthopedic care, CSMO offers advanced sports medicine, orthopedics, interventional pain management, surgery, physical and occupational therapy, and sports performance training. Their team of highly trained surgeons utilizes minimally invasive techniques and cutting-edge technologies to provide a full range of orthopedic surgical care, including arthroscopic procedures, total joint replacements, and spine surgery.
Located in an area experiencing steady growth and offering a vibrant lifestyle, the Chattanooga region attracts individuals seeking affordable living costs, year-round outdoor activities, and a thriving arts and cultural center. The area's strong employment market, featuring major employers in manufacturing, healthcare, and services, has contributed to CSMO's expansion to 11 locations and the recent opening of a state-of-the-art ambulatory surgery center (ASC).
Challenges and Objectives
Despite their reputation for excellence and technological advancement, CSMO faced unique challenges in their payment processes. They previously did not accept appointments with direct-pay patients and lacked the understanding of how to post prices and bundle their orthopedic services effectively. Recognizing the need to adapt to the growing population and consumer preferences in the Chattanooga area, and to support their practice goals, CSMO sought a collaborative solution.
The objectives of CSMO's collaboration with HealthMe included:
- Developing a comprehensive price transparency strategy to foster open discussions about care options and alleviate patient concerns regarding financial surprises.
- Implementing direct-pay options to cater to the increasing number of direct-pay patients and expand their patient base.
- Streamlining bundled services and creating transparent pricing models to enhance coordination, efficiency, and revenue management.
To achieve their objectives, CSMO connected with HealthMe through the OrthoForum, a physician subspecialty organization that includes the largest independently owned orthopedic practices in the United States. This collaboration allowed CSMO’s leadership to engage in a collaborative process with HealthMe, leveraging their expertise in healthcare payments and price transparency strategies.
Recognizing the benefits of price transparency beyond regulatory compliance, CSMO aimed to provide clear pricing that would remove patient concerns regarding potential financial surprises. By working closely with HealthMe, CSMO developed a comprehensive price transparency and direct-pay strategy tailored to their unique capabilities and clinical pathways. This involved determining transparent pricing structures for office visits, evaluations, surgeries, and other procedures. The HealthMe marketplace was seamlessly integrated into CSMO’s operations to provide a streamlined patient experience.
Solution and Results
The implementation of the price transparency and direct-pay strategy yielded significant results for CSMO, positively impacting their financial growth and patient experiences. Some notable outcomes include:
- Direct Pay Market Expansion - HealthMe demonstrated that there is a rapidly growing direct-pay patient population, including self-insured employers, high-deductible health plans (HDHPs) holders, and others. Addressing this population opened new opportunities for CSMO to attract and serve a broader patient base.
- Revenue Growth and Market Reach - Since partnering with HealthMe, CSMO expanded their services to include surgery packages and introduced a dedicated marketplace for sports performance packages. This expansion, coupled with transparent pricing, attracted patients seeking value-based care and contributed to CSMO serving thousands of patients through HealthMe since implementing the partnership. The ability to offer comprehensive bundled services under one roof further enhanced their market reach and positioned CSMO as a destination for musculoskeletal procedures.
- Improved Patient Experience - The price transparency strategy implemented with HealthMe positively impacted the patient experience at CSMO. Clear pricing eliminated financial uncertainties for patients, fostering open discussions with physicians regarding care options.
- Excellence in Customer Service - Moreover, CSMO observed improvements in customer service, as their staff gained a deeper understanding of the cost of care for patients. This awareness led to a heightened appreciation for the value of services provided, resulting in enhanced patient satisfaction.
- Alignment with Self-Insured Employers - With transparent pricing a key element of direct-to-employer contracting, CSMO has made the important step to position the organization to align with the needs of self-insured employers who value more efficient and physician directed care. When timely, quality care is paramount, transparently priced bundles can help assure these employers that their employees receive personalized, doctor-directed treatment, and can quickly return to work and other things related to quality of life.
The collaborative efforts between CSMO and HealthMe in implementing a comprehensive price transparency and direct-pay strategy have proven highly successful. By addressing the needs of a growing direct-pay patient population, expanding revenue streams, and enhancing patient experiences, CSMO has achieved financial growth. Transparent pricing and bundled services have positioned the practice to partner with self-insured employers. This case study exemplifies the significant impact that strategic collaborations and innovative payment solutions can have on healthcare practices seeking financial success and improved patient satisfaction. As CSMO continues to evolve and adapt to the changing healthcare landscape, their collaboration with HealthMe serves as a model for driving excellence in orthopedic care.