BCBSNC Kicks Off Orthopedic Bundles

Jacqueline Fellows, for HealthLeaders Media , February 19, 2013

Daniels gives credit to a prospective payment model for easing payment negotiations between BCBSNC and Duke and TOA, as well as determining appropriate measurement targets.

"We're using the PROMETHEUS model; it does a potentially avoidable complication analysis, and... the contract we have is we want to see a reduction in the percentage of patients who have potentially avoidable complications, also patient satisfaction is key," says Daniels.  "We've got outcome measures that are built into the hospital stay, and then we've got outcome measures that are built into the contract post-discharge."

Daniels says BCBSNC is looking at other bundles, including chronic conditions, which is trickier because of the increased variability. But Daniels says chronic conditions "dovetail" with Accountable Care Organizations and Patient Centered Medical Homes.

"We still have a start and end date with our chronics—it's a one-year time period—and we're just starting to model it, but when you're contracting with an ACO, you're basically looking at episodes of care."

Daniels also says the plan is looking to bundle payment initiatives with outpatient care, particularly arthroscopy. In the meantime, BCBSNC is focusing on knee replacements, with hips not too far down the road.

"At TOA, we're going to review after 60 days how the knee is going, but they're right on board with moving forward on hip replacements," she says.

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