"It's made up of postacute providers who understand how we want them to care for patients," Whittington says. "If they comply, we'll send them more patients."
This kind of transformation isn't a temporary one though, given the infrastructure requirements, says Reeve. "If you're going to be in bundles, you have to do them right, and that means committing resources to data, measuring with data, and working with doctors in a wholly different collaborative fashion," he says.
Where are the savings?
Bajner says one revelation was how much care and cost existed outside the walls of the hospital. In fact, one key question for participation in the ortho bundle, and the subsequent seven or so bundles Baptist has added since, was whether the hospital and the resources developed in conjunction with the surgeons would be enough to manage care effectively in a postacute environment without owning various pieces of the care continuum.
Overall, it's really about redefining how to deliver healthcare, and betting the organization was up to the challenge.
"We do not anticipate losing on anything; that's not how we do business. But you're right: We bet a lot on being able to change the way we deliver healthcare," says Whittington.
Under the ACE program, which is no longer active, Baptist participated in both the orthopedic and cardiac pilots. Now it participates in seven bundles in CMS' Bundled Payments for Care Improvement initiative, in which more than 500 organizations nationwide are testing how bundling payments for episodes of care can better coordinate care, achieve better quality, and lower costs for Medicare. At this point, almost 30% of Baptist's Medicare volume is bundled.
"To be honest, with four of those five we added in April 2015, we were higher than the target price, meaning that we were upside down. So there's that risk," says Whittington. "But we learned from what we did with the ortho bundle that there are things we can do that we've already put in place as a system to help with moving transitional care to the appropriate settings."
He says the biggest savings in all the bundles has come, not surprisingly, from moving away from heavy SNF utilization. Mobilizing home health to help patients stay in the home has been a big satisfier for them—and also a big money-saver.
Philip Betbeze is the senior leadership editor at HealthLeaders.