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Article Title

Care Redesign in Joint Care

Publication Date

8-15-2016

Keywords

care redesign, value

Abstract

Background/Aims: The goals of population health are to improve the health status of defined populations by focusing on quality, cost and experience of care (Triple Aim). With the Centers for Medicare & Medicaid Services’ development of bundled payment programs (e.g. Bundled Payments for Care Improvement, Comprehensive Care for Joint Replacement) as well as other quality-focused advances in the industry, there are increased avenues to incentivize physician and hospitals to collaborate to achieve common goals around quality, experience and cost.

Methods: The efforts focused on leveraging a 9-step care redesign model to evaluate best practices in joint care across 11 state health care systems. Workflows were evaluated and opportunities for care improvement were identified and implemented. The Total Knee Best Practice Change Assessment brought about enhancements, which included the engagement of care management/navigation beginning at the preoperative stage and continuing through the entire episode of care. These efforts included robust patient optimization, education and engagement while leveraging effective analytics to inform our efforts.

Results: Programs that significantly lowered post-acute care costs (specifically, costs related to admission to skilled nursing facilities) achieved substantial savings in post-acute care. In addition, we observed a decrease in readmissions, a decrease in skilled nursing facility utilization and an increase in patient satisfaction. Key lessons learned include: a) the significance of physician leadership in implementing organizational change, and b) the importance of 24/7 patient access to care management to reduce emergency department utilization.

Conclusion: Findings from this study have direct implications for ongoing episode-based payment initiatives aimed at improving quality and decreasing costs, as they suggest that episode-based payment models have the potential to decrease total costs per episode.

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