Image by Mudassar Iqbal from PixabayHolista is expanding its partnership with Oakleaf Medical Network and Cedarcrest Surgery Center.
The move will go a long way toward enhancing patients’ access to affordable surgical care in Western Wisconsin, according to executives from the organizations.
The expanded agreement strengthens the existing partnership between Oakleaf Medical Network’s physician expertise and Cedarcrest Surgery Center’s ambulatory surgical facility in Rice Lake, Wisconsin.
This expansion includes more than 25 bundled episodes, mainly covering gynecological, orthopedic and podiatric procedures.
“This expansion demonstrates our ongoing commitment to partnerships that provide high-value care delivered locally,” Kate Grohall, Holista co-founder and vice president, told ASC News. “These high-value, high-quality community care providers align perfectly with Holista’s value-based products. Philosophically, we agree that high-quality health care should not conflict with the value proposition. Value is a compelling and responsible pricing model combined with quality clinical outcomes and the physician-patient experience.”
Holista is a health care innovation company based in Menomonee, Wisconsin, that focuses on bundled episodes of care to improve quality and reduce costs.
By establishing strategic partnerships with top-tier providers and facilities, the company delivers transparent, coordinated care that benefits patients, employers and the health care system.
In addition to offering a bundled payment model, Holista combines the financial approach with clinical partners and extra support to help patients receive high-quality care.
“We become an extension of the provider’s clinical practice by using technology to clearly inform the patient of what they need to do to meet quality clinical drivers,” Grohall said.
Grohall stated that Holista’s episodes of care, combined with bundled payment models, are promoting not only financial efficiencies but also value-based care.
“Because we prioritize quality and value, our product is a care episode that focuses on wrapping the clinical envelope around that bundle payment arrangement,” she explained. “A bundle only allows some savings, but those savings must be supported by quality and experience standards.”
From Grohall’s perspective, bundled payments combined with clinical care management will create value and improve patient outcomes.
The benefits of bundling
Bundled payments are an alternative payment model designed to promote value-based care by encouraging providers to improve coordination and efficiency, while also boosting quality and outcomes at a lower cost.
For example, a bundle for a knee replacement might include the surgery, hospital stay, rehabilitation and post-operative care up to a certain point, such as 90 days after discharge.
Under bundled payments, the total allowable acute and post-acute costs for an episode of care are predetermined. Participating providers share in any losses or savings that result from the difference between this target amount and actual expenses.
Dr. Keith Smith, medical director and founder of the Surgery Center of Oklahoma in Oklahoma City, said that bundling payments promotes collaboration among everyone involved in the care process.
He describes it as “forced accountability.”
“There is a forced accountability for all members of the care episode,” Smith told ASC News. “Bundling care tasks forces the involved parties to communicate with each other and to be honest, not only with the patient about charges but also with each other.”
These types of payments require participant providers to assume risk because they must cover costs that go beyond the target price for an episode of care, including expenses related to complications and hospital readmissions.
“These arrangements are powerful because we have an agreement with the surgeon about their price,” Smith explained. “If, for some reason, they use more supplies than usual, I am free to adjust what is paid to them to make sure the surgery center doesn’t lose money.”
On the positive side, ASCs are responsible for managing costs within the bundle. They are motivated to improve care coordination and quality to achieve better outcomes and retain a share of any savings.
“It really forces the parties to communicate,” Smith said. “An anesthesiologist cannot charge more than the surgeon for the same procedure. Yet, that happens across the country. Capping payments brings everyone into line and helps ensure that prices stay reasonable and continue to decrease.”
Smith said he founded Atlas Billing Company, a clearinghouse that serves patients at his ASC, to promote transparency. Atlas enables the patient to write a single check for the total cost of the surgery, and the billing company handles paying the providers.
The model also encourages the ASC to collaborate closely with other providers, such as physicians and physical therapists, to comprehensively manage the patient’s care.
Smith observed that patient demand for bundled payments has highlighted well-intentioned, mission-driven providers and set them apart from many who overcharge for services.
“I’m more optimistic about the future than I’ve ever been because there are more [providers] than I initially thought who are genuinely well-meaning and missional,” he said. “I’m encouraged by what I’m seeing happening in the industry right now.”
As bundled pricing becomes more widespread, patients are growing more knowledgeable and are beginning to ask for a “cash out the door” bundled price, according to Smith.
Consequently, facilities offering these plans are attracting patients who might not have chosen them otherwise.
Additionally, these ASCs save money by not needing to staff a revenue cycle management or accounts receivable department. Smith mentioned that his ASC doesn’t even use electronic medical records because the primary reason providers have EMRs is to submit them to payers for proper reimbursement.
In the case of bundled payments, that is no longer an issue.
He said a way to start is to see offering bundled payments as an addition to what they’re already doing and then expand from there.
“Independent ASCs have an advantage over hospitals because they’re so nimble that if someone asks for a bundled price, an ASC can provide that fairly quickly,” Smith said. “A hospital or hospital-owned ASC will not be able to turn that around quickly. So smaller, independent ASCs have a significant advantage as patients continue to demand bundled payments.”
In the future, Smith believes more ASCs will adopt bundled payments to attract a different clientele.
“They’ll draw in more of the current self-funded clients seeking a facility that offers bundled payments,” he said. “There really is no downside.”
