Our services are effective because they are built to be fair:
We Build Intelligent Bundles
Bundling care is not only an effective way to improve outcomes, but also an opportunity to save money in the process. However, developing a fair and effective bundle requires more than just adding together the costs of each component of care. After all, each patient and procedure presents specific risks and care requirements that can dramatically effect costs. A simple bundle can’t account for these possibilities. An Intelligent Bundle can.
Risk Adjustment – Our modeling approach identifies the risk adjusted cost for routine care and adverse outcomes, permitting more accurate bundle pricing and greater opportunities for savings.
Appropriateness – Our bundles are designed by physicians who understand appropriate care delivery. That means that in our bundles a doctor’s choices aren’t guided by cost alone—they are guided by what is cost-effective. That’s just intelligent.
Continuous Improvement – Intelligent bundles are based on what your best performers are doing now. A feedback loop is built into the bundles as well, encouraging continuous improvement.
How We Build the Intelligent Bundle – To build our bundles MPA analyzes routine costs and costs associated with adverse events separately, creating multiple predictive models that account for a patient’s inherent risk. Hundreds of risk factors are considered—including demographic, socioeconomic, patient and procedural risk – in the development of every predictive model. The models are then standardized to demonstrated good performance from both a quality and cost perspective.
For each case a warranty, which serves as a reserve fund for adverse events, is calculated based on the experience of good performers and added to the routine costs. Predictive models are updated periodically with more recent data to capture changes to the risk factors and improvement in cost- effective care. This allows for a process of continuous improvement at the provider.
The result is a bundle that is fair and effective for physicians, providers, and payers, alike.
Comprehensive Care for Joint Replacement (CJR)
CMS gave its final sign off on the mandatory bundle program known as CJR to begin on April 1st, 2016. The CJR requires approximately 800 hospitals in 67 areas across the country to participate in bundle payments for knee and hip replacement (DRG 469 and 470). Here is how MPA Healthcare Solutions can help you succeed in the program.
Benchmark Your Performance – Because you will ultimately be measured against the average of other providers in your MSA you need to understand how your costs and quality compare to theirs. This will give you a sense of how much work needs to be done to avoid penalties and gain payments.
Evaluate your Partners – The CJR looks at your total cost for the procedure going out 90 days post-discharge. That means where your patients go after they leave your care can have a dramatic impact on how much you get paid. CMS star ratings may be helpful in some cases, but MPA Healthcare Solutions can help you understand who to partner with and how to improve.
Determine you Gainsharing Strategy – The more you depend on physicians and post-acute care partners to manage clinical and financial risk, the more you should employ a gainsharing strategy. Let us develop an approach that is fair enough to achieve buy-in from all partners and effective enough to drive results.
Reduce Your Clinical Cost and Risk – MPA Healthcare Solutions can help you better understand your patient population through risk-adjustment techniques that identify true adverse outcomes. Understanding the interaction between length of stay (LOS), readmissions, and post-discharge deaths will help your clinicians make better site of service selections.
Virtual Partnerships Increase Savings, Fairly
The key to significant savings in the world of bundled payment is engaging physicians to reduce practice variance and to adopt practices that deliver cost-effective care.
The MPA Virtual Partnership makes that – and more – possible.
Our Intelligent Bundles provide a budget for the cost of inpatient care. With our MPA Virtual Partnerships, doctors are asked to work within that objectively fair budget.
- If they can provide good care for their patient population for less than the budgeted amount set from the Intelligent Bundle, they share in the savings.
- If they go over budget, they are penalized.
This gives them a strong incentive to deliver cost-effective care and discover new savings opportunities that maintain or improve outcomes.
With this approach, the losers are the companies that make money selling services to the physicians that do not add value. Put another way, in MPA Virtual Partnerships, cost reductions are realized by physicians eliminating services that do not benefit their patients – and that’s how it should be.
Aligning provider and payer priorities
GlobalPRIME™ extends the MPA Virtual Partnership concept to include payers.
A budget, established from our Intelligent Bundles, is based on the cost of care for that specific provider. When the provider provides care for its patient population for less than the budgeted amount, they share in the savings. The effect is to reduce costs significantly at both the provider and the payer.
Savings can be substantial as payers establish GlobalPRIME™ at multiple providers.
Savings are never derived from random spending cuts. Instead, they come from reduced spending on the items and services that the provider deems to be least value-added. That way you can be sure you aren’t sacrificing quality outcomes for your members. On the contrary, you are making sure they are getting better value for their money.
MPA Healthcare Solution’s fair approach to payment reform leaves everyone a winner.
- Hospitals like our system because doctor priorities align with hospital priorities, resulting in lower costs without requiring a complicated system or the purchase of physician practices.
- Doctors like our system because they share in the savings they create by delivering cost-effective care. Our system also can provide them with clear guidance about what is working and how to improve.
- Insurers like our system because paperwork is greatly reduced and simplified.
- Patients like our system because they will receive the best care for the right reasons. Because they can receive a single bill that encompasses all of their care, our system reduces complexity and confusion.