Deploying Transparently Priced Bundled Care to Impact Patient Outcomes and Financial Performance

Among the HealthMe client community, many practices have enlisted the help of our highly regarded Client Success team to help them build accurate and fairly priced surgical bundles.  Perhaps counterintuitively, listing prices for surgical bundles – something that many specialist practices would consider to be a “trade secret” – can lead to a competitive advantage for independent groups. At HealthMe, we’ve seen time and time again how transparently priced surgery bundles can help practices achieve advantage in both reputation for quality and patient experience.  This post will explore this finding in more detail, but let’s take a few minutes to review some background on bundled pricing for surgical care.

Origin of Bundled Care

The concept of bundled care is not new but has gained more widespread adoption in the United States over the past 15-20 years.  The initial reasons for doing so centered around efforts to improve patient outcomes, reduce costs, and increase efficiency.  Next, the Centers for Medicare and Medicaid Services (CMS) promoted the use of surgical bundles through their Comprehensive Care for Joint Replacement (CJR) model, which began in April 2016 and will run through December 2024. It aimed to incentivize providers to deliver higher-quality care while controlling costs, as payments were tied to the entire episode of care rather than individual services.

Bundled Care for Orthopedics

For independent specialty practices and for those serving the rapidly growing universe of direct-pay patients, “owning the bundle” has a unique set of challenges. Practices have been slow to adopt strategies that clearly articulate how bundling works and what patients can expect—especially from a pricing standpoint.  Take for instance, orthopedic surgeries, which often involve multiple procedures and follow-up therapies, there are frequent variabilities that can involve coordination with surgery centers, imaging, physical therapy, and others.

Regardless of the payer in the self-insured ecosystem—including patients themselves—transparently priced surgical bundles can play a vital role in improving patient safety, outcomes, and overall healthcare quality by standardizing care and incorporating evidence-based practices throughout the surgical process.  As patients take a more consumer driven approach to their care, the ability to present transparent pricing has taken on added importance—which can help lay the rails for enhanced financial performance in an increasingly competitive market.

Five Reasons to Offer Bundled Care Options

Building transparently priced surgery bundles can provide significant benefits for independent orthopedic practices.  Here are five compelling reasons to consider building your bundles:

1. Increased Patient Engagement: Patients value honesty and open communication.  By providing clear pricing information about the total cost of surgery (bundles), patients make informed decisions and feel more confident about their choices.
2. Competitive Advantage: Consumerism in the increasingly competitive healthcare market is here to stay.  Direct pay patients as well as the self-insured ecosystem of navigators, TPAs and a suite of direct to employer contracting organizations are looking for the highest quality and most cost-effective surgical options.
3. Simplified Decision-Making: Orthopedic surgeries can involve multiple procedures and follow-up therapies.  Patients may have concerns about costs so publishing transparent bundled prices simplifies the decision-making process for patients.
4. Improved Financial Planning: Clear pricing information allows patients to plan their finances accordingly. They can review and compare costs without the need for multiple phone calls or in-person consultations, saving both their time and that of the practice.  Direct payment for surgical bundles also reduces the likelihood of payment issues or unexpected billing concerns.
5. Enhanced Practice Reputation: The OrthoForum states that, “Pricing transparency has become a hallmark of high-quality and customer-focused practices.” Positive patient experiences, backed by transparent pricing practices, can lead to increased patient satisfaction, positive online reviews, and referrals, further bolstering the practice's reputation.

Who Owns the Bundle and Why that’s Important

When we speak of “owning the bundle,” we imply that the party that collects and allocates payment streams will always have control over the payment made to physicians, vendors, and suppliers.  This involves the advance negotiation of fair and reasonable fees with the facilities, implant vendors, imaging, PT, and others.  Additionally, the practice will market your self-pay surgeries directly on your website.  When you own the bundle, you and your practice are in control of the healthcare revenue stream, not third parties.

Additionally, transparent priced bundles can help provide you with invaluable exposure to self-insured payers who are seeking accountability, predictability, and the ability to get employees back to work quickly.  The HealthMe platform and clients-success team is purpose built to give the tools, knowledge, and support for owning the bundle and direct pay success.

Conclusion

As a physician founded company, we know firsthand the challenges and frustrations of navigating the healthcare landscape.  This is why we have invested years of  research in the pricing of healthcare services in addition to developing a hardened and proven software platform that is purpose built to deploy transparently priced surgical bundles for direct payers.  The rapidly growing landscape of these payers—ranging from self-insured employers to patients themselves—represents an undeniable market force which must be addressed.  Our team at HealthMe has helped many of the nations’ leading independent orthopedic practices develop and deploy strategies to meet this need.  Contact us to find out how.

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