This nationally recognized healthcare system looked to Numerof for help preparing for bundled payments. In addition to providing a plan the organization could rally around, we helped them better manage variation in cost and quality, develop evidence-based care paths, and achieve meaningful improvements in the current fee-for-service environment.

Situation

• This nationally recognized healthcare system sought to preserve its leadership position and ensure its continued clinical and financial success as it faced growing pressures to more proactively manage clinical variation, reduce costs, and increase revenues.
• To support its preparation for anticipated reimbursement changes, the organization engaged Numerof to assess its readiness for bundled payment, ensure organizational alignment to evidence based care paths, and proactively manage variation in cost and quality.

Intervention

• Using two core service lines as the basis for establishing an initial framework for action, Numerof assessed the availability and accessibility of data on the organization’s underlying resource costs and clinical outcomes as an input into the development of bundled pricing. We created a roadmap for obtaining such data and recommended next steps to ensure estimates supporting external pricing efforts are accurate.
• We assessed the current state of organizational infrastructure and alignment to support service line competitiveness based on differentiated outcomes in an environment of price transparency. We identified gaps and recommended specific steps to close them.
• Numerof engaged clinicians and analyzed clinical and financial data to identify specific opportunities for reducing undesirable clinical variation, lowering costs, and improving the consistency of program quality.
• Working closely with clinicians and building on existing tools, we developed evidence-based predictive care paths for key services.
• We also developed service line-specific dashboards to assist the organization in identifying and collecting important clinical and financial data in real time.

Impact

• Numerof’s concrete recommendations helped the organization move toward more cost-effective, evidence-based care, with benefits to margins and outcomes in today’s model.
• Our work clarified accountabilities for key roles and created a blueprint for the organization to develop bundled price offerings.  Although the initial work focused on two major service lines, many of our recommendations were applicable to the entire system; they were adopted and implementation is ongoing.
• Numerof’s guidance identified ways to monetize the value of the organization’s care model. Despite continued reimbursement pressures, the organization enjoys healthy margins and employee incentive payouts based on corporate performance.