|A Quarterly Publication of HCI3||Volume 1, Issue 4 | January 2012|
In this issue of Improving Incentives you will read about the launch of a new bundled payment initiative in Wisconsin, led by the Robert Wood Johnson Foundation’s Aligning Forces for Quality effort in that state. Payers (yes, more than one) and providers (ditto) have contracted for knee replacement bundles and at least one case has been triggered. You’ll also read about a three-year pilot project covering several million people in Stockholm County, Sweden, where Swedes are getting total knee replacements under a bundled payment program in which providers offer an explicit warranty. This pilot is reminiscent of one of the original bundled payment pilots in the United States, launched in Michigan by Lanny L. Johnson, MD, in 1993. It shows now in Sweden what it showed then in Michigan: that providers can improve margins while still controlling costs to the payer, and that patients get better care.
Providing higher quality and more affordable care is the challenge physicians, hospitals, and all care providers face in the United States. Tom Lee, MD, the head of the network for the Partners HealthCare System in Boston, knows the challenge better than most and translates it here for us in a set of simple yet critical “come to Jesus” questions that all physicians must ask themselves if they want to be part of a real patient-centered team. Alice Gosfield, chair of the HCI3 board and renowned health care lawyer, further delineates the real tests of clinical integration that come to the fore when providers are at financial risk for producing a warranted bundle such as those in Sweden and in many implementation sites in the United States.
These sites are poised to grow significantly in number as providers across the country apply for the CMS Innovation Center’s Bundled Payment pilot in a few months. To help them in that process, we’re putting the finishing touches on a free SAS-based application that will help them calculate an episode price for some of the more frequent hospitalizations Medicare beneficiaries incur. This application conforms to the requirements of the CMMI Bundled Payment pilot and facilitates the application process.
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Francois de Brantes