Care packages a new approach to common conditions

Doug Koekkoek, M.D.
Chief medical officer, Oregon Region

June 12, 2013

From total joint replacement, to pregnancy care and coronary artery bypass grafts, the Oregon Region is exploring a new way for providers to collaborate on evidence-based models of care.
 
These care packages, also referred to as “bundles,” cover episodes of care from the initial consult to post-discharge for a single fee.

The aim is to ease our patients’ way while lowering costs through coordinated and standardized care. This is a departure from the current method of care delivery in which each provider does his or her part and submits a bill for services, resulting in price variation. Care packages require considerable planning to assemble a team and a reliable care structure that also assumes financial risk for outcomes.

Under Providence’s pilots, now in various stages of implementation at Portland-area hospitals and clinics, providers and teams from many disciplines are developing protocols and care pathways based on best practices. The total joint replacement care package is furthest along, and is reporting good results. We’ll share those in a future issue of Pulse. In the meantime, here’s a status update:

Pregnancy care package
This redesigned, team-based model of pregnancy care spans prenatal, labor and delivery, and postpartum and post-discharge phases. Anchored by certified nurse midwives, the model involves RNs, patient navigators and doulas, who provide connected care across the prenatal clinic and hospital settings.

Goals:
To reduce the overall cost of pregnancy care by at least 15 percent while sustaining or improving outcomes and patient satisfaction.

Who’s served:
Pregnant women cared for by Providence certified nurse midwives who deliver at Providence Portland Medical Center.

Status:
Demonstration began in January at Providence Maternal Care Clinic and in April at Providence Portland Medical Center.

Expansion:
To be determined after results are analyzed; potential to spread throughout the Oregon Region.

Sponsors:
Kathy Criswell and John McDonald, M.D.

Total joint replacement care package
This provider-driven model delivers all services related to elective total hip and knee replacement for a single fee with a warranty. Services span 30 days before surgery through 90 days post-surgery.

Goals:
To reduce episodes-of-care costs by as much as 5 percent, improve patient experience as measured by Press Ganey scores and provide superior functional outcomes.

Who’s served:
Providence Health Plan commercial and Medicare Advantage members. Oregon Public Employee Benefit Board (PEBB) were added this month.

Status:
The pilot was launched in June 2012 at Providence St. Vincent and Providence Portland medical centers.

Expansion:
Will spread to other payers and potentially throughout the Oregon Region.

Sponsors: Karen Foley and Tom Lorish, M.D.

CABG care package
Also provider-driven, this package covers services and treatment related to coronary artery bypass grafts, from presurgery patient education through post-op follow-up and physical therapy.

Goals:
To improve patient outcomes throughout the care continuum, reduce costs by at least 5 percent and enhance the patient's experience.

Who’s served:
Patients receiving an isolated CABG at Providence St. Vincent Medical Center.

Status: The pilot began on May 1.

Expansion:
To be developed at Providence Portland Medical Center over the next two years, then potentially throughout the Oregon Region.

Sponsors:
Kristy Wayson and Daniel Oseran, M.D.

These packages cover three of the 10 highest-cost conditions, according to the federal Healthcare Cost and Utilization Project. By coordinating and standardizing care, we can offer cost savings to payers while still providing the best care for our patients.

This is only one step toward reimagining health care, but it’s an important step.