Orthopedic procedures are generally seen as one of the easier episodes of care to fit in a bundled payment model, says Minoo Javanmardian, PhD, and co-author of a recent study showing strong consumer support for bundled healthcare.
"It appeals to patients and to providers and payers," she says. "If you get a knee replacement, there is beginning, there is a middle, and there is an end. Ortho bundles are attractive to patients because they want the problem solved and they're more likely to take a risk with a new payment model... it's easier for them [patients] to wrap their heads around it, 'I walk in, I get my surgery, my rehab, then walk away.' "
The way BCBSNC structured its knee replacement bundle includes more pre-operative care. Daniels describes the process as a "roadmap" for patients. She says the plan's utilization management nurses and TOA's pre-operative care team work together to determine the date of surgery as well as several things to reduce variability and cost while increasing quality.
"TOA has a physical therapist go into the patient's home look at the home setting to see how they're going to navigate at their home after the surgery," says Daniels. "They give them [patients] PT exercises to strengthen their core, and they've got a special prep kit [for patients]... to reduce infection."
The new payment model means patients will pay one, fixed-rate bill for 30-days pre- and 90-days post-surgery for knee replacements.