MACRA patient engagement cheat sheet No. 4: Patient engagement strategies for bundled payments

Bundled payment programs are a type of value-based care program that have become much more significant with the emergence of the Medicare Access and CHIP Reauthorization Act. For the first time, a bundled payment program, the Comprehensive Care for Joint Replacement initiative, is mandatory for some providers rather than just optional. CMS has signaled that this is the beginning, not the end, of mandatory payment bundling for specific episodes of care. Also, on the private payer front, payment bundling is rapidly gaining interest. Boeing and United Airlines have negotiated specific bundled payment programs with certain providers, and other private payers and large employer groups are doing the same.

Therefore, it’s essential that large provider organizations that wish to continue to provide episodic surgical care prepare for payment bundling. One way to improve bundled payment performance without needing any changes to clinical workflows or protocols is to engage patients before and after their care episode. By doing so, provider organizations can improve both the efficiency of the entire care journey and the aggregate outcomes for their patient populations, both of which are key to successful performance in a bundled payment program.

Prior to any significant episodic procedure, particularly one involving surgery, there are a number of steps the patient will need to take, things that the patient should know, and instructions they should follow. In the past, these items would be communicated to the patient verbally or via printed handouts. Now, these instructions can be supplemented with 24/7 online access to vital information as well as tools, such as notifications and reminders, giving the patient what they need when and where they need it. By providing patients and their family members with electronic access to the necessary information and instructions, provider organizations can improve the number of patients that successfully complete their responsibilities. This means less manual follow up and fewer missed or rescheduled appointments, saving provider organizations time and money.

Even more important than efficiently delivering the quality outcomes needed to succeed with bundled payments for procedures is getting the patient to perform the follow-up tasks as directed. Whether it be taking antibiotics to stave off infection or attending all prescribed physical therapy appointments, the overall success of a procedure can depend on the patient and their behavior. Giving a patient information about the importance of these events and automated prompts to remind them when it is time to complete these tasks greatly improves adherence to medical instructions. Provider organizations don’t have the staff to manually follow up with patients so, sometimes, patients never complete the follow-up care needed to give them the best possible chance at a positive outcome.

Some of the patient activities that can be facilitated and encouraged through patient engagement—such as physical therapy sessions, imaging studies, or follow-up consultations—are also revenue opportunities for the provider organization. A patient engagement platform can provide patients with convenient reminders for these events, information on why these events are important to their health, and allow them to schedule these events in a self-service manner. Thus, these organizations have a second reason to invest in a system capable of getting the patient to complete these activities without any additional effort on the part of provider personnel.

The patients also appreciate having this information and these tools at their fingertips. This can improve patient satisfaction scores that may be measured as part of a bundled payment program. More importantly, as passive patients become active consumers and start making more and more decisions about their care, including where to have procedures completed, it’s critical to provide quality customer service. Patient-convenience features, like reminders and online appointment scheduling, can improve word-of-mouth among patients on social media and in more traditional forms of communication.

Bundled payment scenarios are not fundamentally different from other patient engagement use cases. However, they do offer additional ways that organizations can benefit from a strategy to meaningfully engage their patients using technology. Patient engagement around bundled payment episodes of care offers a three-in-one value proposition: improve outcomes efficiently, drive more fee-for-service revenue, and improve customer experiences. A patient engagement solution solely for bundled payment episodes would be a very narrow investment, but other forms of value-based care, the rise of consumerism in healthcare, and other market forces are increasing the demands to engage patients meaningfully. It only makes sense for healthcare provider organizations to plan ahead to ensure that any patient engagement investment they make also pays dividends in relation to their bundled payment program participation.


Mr. Heaney is a founding partner of Get Real Health.

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