Blog Post August 21, 2019 Building Off a Successful Comanagement Arrangement Authors John Fink Previously, we discussed how to improve underperforming comanagement arrangements. What about those arrangements that are succeeding and enhancing an organization’s quality, patient satisfaction, and costs: what’s next? Perhaps you’ve been able to expand services and access points and continually bolster service line performance by managing relevant metrics. How do you take advantage of the improvements you’ve made and further advance the service line? Here are three possible strategies to help grow volume, improve profitability, and solidify alignment with physicians. 1. Expand Your Bundled Payment ArrangementsIf comanagement has been effective and your service line is providing value, then you should also be successful with value-based arrangements. If you aren’t already seeking opportunities to bundle, here are three reasons to start: Employers Are Seeking Savings: A bundled payment pilot can strengthen relationships between providers and local employers, potentially even opening up discussions about additional services and models.Insurers Are Becoming More Price Sensitive: It is crucial that providers understand their true costs. Bundled payment arrangements can help better identify and track costs per episode and reduce spending where necessary, ensuring prices remain competitive.Mandatory Medicare Bundles Are Coming: Choosing to pilot bundled payments while many of these programs are still voluntary helps providers gain competencies, as they have more flexibility to determine their engagement. In collaboration with their employer, a provider can carve out certain services, diagnoses, and readmissions and put caps on the payment they take risk for.Hopefully, you are already participating in BPCI Advanced or have applied for its second cohort. The second cohort of applicants will be receiving historical claims data, target prices, and participation agreements in September 2019. 2. Get Ranked and Rated Well The second way to move ahead is by gaining recognition in the U.S. News & World Report’s Best Hospitals: Specialty Rankings and improving ratings in the Best Hospitals: Procedures and Conditions. Doing so can greatly enhance a hospital’s reputation and provide a halo effect for other service lines. But getting into the specialty rankings and improving a hospital’s procedures and conditions rating takes time, as both use data spanning several years. The Best Hospitals: Specialty Rankings provides guidance for patients with complex, high-acuity cases across 16 specialties. Only the hospitals with the 50 highest scores in each specialty are ranked. For most specialties, hospitals are analyzed based on four elements: survival (37.5%), care-related factors (30%), expert opinion (27.5%), and patient safety (5%). In the latest report, only 158 hospitals of the over 4,500 hospitals evaluated performed well enough in specialties to be ranked a Best Hospital. More information about the methodology for specialty rankings can be found on the US News website. The Best Hospitals: Procedures and Conditions rating works differently than those for specialty rankings and focuses on commonly occurring conditions and medical procedures that are typically provided at hospitals. Hospitals receive ratings of “high performing,” “average,” “below average,” or “no rating” (for hospitals with low volume in the procedure/condition) for the following procedures and conditions: Abdominal aortic aneurysm repair Aortic valve surgery Chronic obstructive pulmonary disease (COPD) Colon cancer surgery Heart bypass surgery Heart failure Hip replacement Knee replacement Lung cancer surgery3. Tell the World about Your Success You’ve worked hard to enhance the performance of your service line – why keep it a secret? Information about a hospital’s quality, outcomes, and patient satisfaction is often hard to find or unavailable on the hospital’s web site. Many hospitals simply direct consumers to Hospital Compare. You should enhance awareness of the excellent care provided at your facility by publishing an annual outcomes report for each major service line and/or the hospital as a whole. Publicly reporting the quality and outcomes of your program will have the following effects:Support high scores on transparency in the Best Hospital rankings and ratings.Facilitate physician recognition as being one of the best five places for complex or difficult cases in the area, therefore improving your Best Hospital expert opinion score.Influence consumers, who are increasingly comparing hospitals when seeking care.Force the organization to continuously improve.Good examples of hospital outcome reports are unfortunately hard to find. Below are links to orthopedics outcomes reports of three health systems that provide a range of approaches to reporting outcomes. NYU Langone Health’s Orthopedic Surgery 2018 Year in ReviewAnne Arundel Medical Center Orthopedic’s 2017 OutcomesMaine Health’s Orthopedics & Sports Medicine 2018 Innovations & Outcomes Report Hoag Orthopedic Institute (HOI) has been publishing its outcomes report since shortly after the hospital opened. It is among the most transparent, comprehensive, and consumer-friendly outcomes reports. All of HOI’s outcome reports can be found on their website. What’s Next?It’s time to use your comanagement arrangement to advance the service line toward national recognition and to benefit from the value it provides to patients, employers, and payers. Challenge stakeholders, including the management company that the hospital has engaged to manage the service line, by pursuing bundled payment arrangements, striving for national rankings and high performance ratings, and publishing the service line’s outcomes.