The payment model assesses surgical necessity; bundles payments for certain elective surgical procedures; ensures appropriate site of care and use of Centers of Excellence; and manages post-surgical care.
A value-based care and payment model saved insurance plan sponsors an average of 50% per surgical procedure, according to a new analysis.
The BridgeHealth model assesses surgical necessity; bundles payments for certain elective surgical procedures; ensures appropriate site of care and use of Centers of Excellence; and manages post-surgical care.
BridgeHealth is part of Transcarent, a consumer-directed health and care platform for employees of self-insured employers and their families.
The national claims study, conducted by MorningStar Actuarial Consulting, analyzed two years of surgical procedures managed through BridgeHealth against a benchmark of $253 billion in paid medical claims associated with self-insured employers.
Among the findings:
- BridgeHealth's model provided an average overall net savings of 49.5% per procedure.
- Savings were reported in two key area: bundled case rates and shifts to the appropriate site of care.
- Per surgery savings varied from 40.3% for orthopedic surgery to 76.9% for spinal surgery.
- This savings analysis did not include the positive effect of fewer complications, decreased presenteeism, lower absenteeism or faster return to work.
- No credit was applied for avoiding inappropriate surgeries.
BridgeHealth serves 1 million members with more than 160 Centers of Excellence and Ambulatory Surgery Centers, more than 300 pre-negotiated surgical bundles across eight surgical categories, and results in 80% lower complications.
With the BridgeHealth model, employees of self-insured employers and other plan sponsors who may need surgery work with a dedicated care coordinator who guides them through the coordination process and connects them to the appropriate care setting for the procedure.
Alexandra Wilson Pecci is an editor for HealthLeaders.
