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Package Pricing

Package Pricing. One Approach to Bundled Payments. Package Pricing: Overview.

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Package Pricing

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  1. Package Pricing One Approach to Bundled Payments

  2. Package Pricing: Overview • The purpose of this presentation is to share the process that the Cardiac Package Price team followed to ensure a successful product. Depending on your product, there may be variations to this process. This is intended as a guide. This is a working document that should be updated by future teams to reflect your own unique experience as you progress through the process so that all projects to follow can benefit from our learnings.

  3. Package Pricing • Team Charter • The Team Charter is a document to create during the project kick off. It helps bring the team together on the purpose of the project, the scope, the team members and their role, and lays some of the ground rules. • Driver Diagram • The Driver Diagram provides the Aim, the primary drivers, and the secondary drivers that help you focus on those items that will provide you success. Initially, this document was used a lot to keep us focused on the end goal. Eventually, this document is only referred to when there is confusion or we needed clarity.

  4. Package Pricing: Assumptions • There were several assumptions that we made early on. These proved to be accurate, and did serve as a reminder that we needed to encourage some of these assumptions in order for them to become reality. • Requires a team to execute – individually we did not have the expertise to succeed. We relied on each team member to attend meetings fully engaged, to make progress outside of the team meetings, and to work collaboratively and patiently as we learned along the way. • Ongoing review and feedback with providers to ensure their buy-in with each deliverable. We decided early on that we could not work in a Bellin vacuum. It was essential for us to continually bounce ideas, thoughts, and strategies off of the provider and key stakeholders to ensure that Bellin’s final package priced product was going to be a product that the everyone was excited about.

  5. Package Pricing: Define Customers and Determine Products • These are the process steps that the Cardiac Package Price team developed. We encourage you to add details as your team learns. • 1. Define Customers Employer vs General Public vs Population/Broker/ Insurance Company based on the demographics of a targeted population • Get statistics on health of identified population (get assistance from decision support and business health solutions) • Select Pilot customer • 2. Determine Products based on specifications in the Driver Diagram secondary drivers • Example: Product 1 = Heart cath. Product 2 = Imaging Package • per member, per month package for managing coronary heart disease for a population Define all components of product across the continuum (across all 5 views of the production system)

  6. Package Pricing: Determine Provider Services and Compensation Structure • Determine Provider Services and Compensation Structure • Identify all physicians/providers who participate in the delivery of the product • Evaluate status of each (Employed vs. Independent) • For those that are Independent negotiate professional fees, and partner with legal services to draft a contract for payment • Operationalize compensation for Independent parties • For employed physicians, regular RVU/compensation built in contract will follow

  7. Package Pricing: Patient Experience • 4. Identify and Determine Patient Experience • Create a detailed Product/Patient Process flow • Identify best practice guidelines • Create Patient Compact • Review Patient Experience with the Customer • Identify patient experience manager for the pilot • Review with providers and obtain their feedback

  8. Package Pricing: Clinical Pathways • 5. Identify and Determine Best Clinical Pathway for the Patient • Determine process and outcome measures • Ensure EHR is leveraged to support clinical outcomes by designing workflows that support clinical protocols • Review Quality measures with the customer • Identify quality control manager for the pilot • Ensure patient compact is executed during pilot with patient engagement • Review and maintain current patient education materials • Consider what type (if any) guarantee is needed post procedure • Review with providers and obtain their feedback

  9. Package Pricing: Efficiency • 6. Maximize Efficiency and Create Lowest Cost Platform for Care • Streamline the supply usage to minimize medical supply costs • Ensure no unnecessary waits and delays built into the process • Ensure all efforts are in place to prevent any clinical complications • Manage variation in clinical practice

  10. Package Pricing: Determine Price • 7. Determine Pricing • Get input from the Revenue Cycle Management Team • Review a sampling of current charges and payments by product and payer types • Identify all revenue codes and CPT codes that is in scope as part of the package price. • Compare current pricing to best in market • Be sure to look at the Average Net Revenue compared to HMO/PPO to what the customer is currently paying • Revenue cycle representative partners with CFO to determine appropriate level of discounting • Partner with Employer Health solutions in engaging the broker if appropriate • Present proposed pricing to customer for feedback • For products which involve independent providers, consider professional fees in price • Determine final pricing • Present proposal to customer

  11. Package Pricing: Determine IT Supports and Pilot • 8. Determine IT/Decision Support requirements • Meet with IT to create project request/estimate • Meet with IT to finalize needs • Build minimal Epic pilot as needed • Meet with DS to finalize reporting needs • Build minimal reports • 9. Execute the Pilot based on Specifications • Engage stakeholders (i.e. physicians & various departments that these patients will be flowing through)

  12. Package Pricing: Evaluate, Spread,and Improve • 10. Evaluate the Pilot based on Specifications • Improve the process as needed • 11. Spread to other Employers/Customers/Products • Based on pilot results and market demand, spread the package price to other areas of the business. • 12. Continually Improve • Keep current on changes in evidence based practice – modify clinical pathway as needed

  13. Package Pricing: Driver Diagram

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