Cardiovascular patients often require significant care, and the default has long been to provide that care in a hospital inpatient setting. But the cost of inpatient care is extremely high, and most patients can achieve the same (or better) outcomes at a much lower cost outside of a hospital.
CardioVascular Care Providers (CVCP), a physician-led organization in Texas, wanted to shift away from the fee-for-service mentality that has long dominated the U.S. healthcare system. To do so, they would have to design a bundled payment program that aligned provider incentives with clinical and financial performance. Other objectives CVCP wanted to achieve included maximizing resources, reducing variability in care, and lower total cost of care.
“Patients with high-risk cardiovascular conditions require specialist treatment, close monitoring, and intervention to manage their disease. Outcomes are often better and costs can be reduced—and more predictable—if patients can receive effective care outside of the hospital and avoid having to be admitted.”
Value-based care is the future of healthcare, but for many providers and organizations, the steps to get there are not entirely clear. CVCP knew they would achieve better outcomes and lower costs with a committed network of care providers participate in a value-based care contract, and set out to create a center of excellence focused on their goals of higher quality and lower costs.
They identified physician champions who understand the importance of VBC, and how to achieve it. Those providers shared their knowledge with collaborators to build confidence and foster success. They evaluated provider performance on key cost and quality metrics, identifying and recruiting physicians with a shared vision of using value-based care and alternative payment models to improve care.
CVCP also knew technology would play a critical role in their ability to realize cost savings in bundled payments. That meant a software solution from a company with a proven track record in VBC alternative payment models. They chose to implement Cedar Gate Bundles Adjudication software, and also to take advantage of the expertise at Cedar Gate by adding managed and consulting services. Cedar Gate’s software provided the necessary tools to implement a bundled payment program, hold providers accountable for outcomes, manage risk, and efficiently administer payment.
With all of these pieces in place, CVCP established a cardiovascular center of excellence where patient outcomes, care quality, efficiency, and cost savings are paramount. Providers are focused on reducing variations and move away from a fee-for-service revenue model.
Collaboration holds the key to achieving better health outcomes and keeping costs down for patients, especially those that are at higher risk of negative cardiovascular health outcomes. CVCP and its partners built a seamless data sharing operation with a focus on what is best for patients.
Participants in the CVCP bundled payment program knew that data sharing was the key to mitigating risk, lowering costs and improving care quality and outcomes for their highest-risk cardiovascular patients. They aggregated data so they could use it to predict costs and reduce variations in care. That data aggregation also paved the way to negotiate a prospective bundle with a global, predictable fee for an episode of care with a payer organization
Comprehensive data analytics are at the heart of successful alternative payment models in VBC. With Cedar Gate’s tools and consulting services, CVCP had actuarial algorithms to create customizable bundle definitions and incorporate clinically appropriate measures, provider performance metrics, and cost benchmarks. Then they could model mutually beneficial contract terms and choose the bundled products that appealed to patients and providers interested in cost and quality.
Seamless data sharing is often a barrier for truly collaborative healthcare. Cedar Gate made it easy for participating providers to share monthly and quarterly reports on bundled contract activity with the payer. The payer also made information from member records transparent so providers could use it to predict risk and steer appropriate patients away from hospital inpatient care to lower-cost settings.
With the help of Cedar Gate, CVCP successfully implemented a bundled payment program that shifted a significant volume of cardiovascular care from costly hospital inpatient settings to other, more appropriate care settings. The results were staggering:
Another key benefit of the CVCP center of excellence is harder to measure, but still critically important for the future of value-based care. Providers and payers who want to participate in VBC contracts, but would have difficulty negotiating the terms on their own, now have the tools to develop successful agreements. CVCP can also easily identify high-performing providers in the contract (and those in the area who are not part of the center of excellence) to build a team committed to achieving VBC goals.
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