In Health Care, À La Carte on Way Out?

New bundled payments offer glimpse into future

MILWAUKEE--(BUSINESS WIRE)-- For years, health care has been paid for on a procedure-by-procedure basis, with items such as doctor fees, lab fees and facility costs all billed separately. This has not only resulted in patients receiving multiple mailings from their insurer after a procedure, but also made estimating out-of-pocket costs before a procedure extremely cumbersome for all but the most well informed consumers. Now, this may be beginning to change.

In an effort to provide high quality care, potential cost savings and increased clarity for its members, Anthem Blue Cross and Blue Shield has entered into “bundled payment” arrangements for select surgical procedures at the Orthopedic & Sports Institute of the Fox Valley in Appleton, Wis. and at Manitowoc Surgery Center in Manitowoc, Wis.

A “bundled payment” groups and coordinates all of the charges associated with a surgery and recovery together for one pre-negotiated price. This means an individual can quickly and easily understand their potential out-of-pocket costs before surgery and results in greatly reduced paperwork for all involved.

“Think of a bundled payment like a restaurant offering a complete meal for $20 deal,” said John Foley, regional vice president of Provider Engagement and Contracting for Anthem Blue Cross and Blue Shield in Wisconsin. “You know if you choose that option that you will get a great experience that includes an appetizer, entrée and dessert, and you know what it’s going to cost before the bill hits your table. That’s a bundled payment.”

“The alternative is an à la carte meal, where each item you order goes on your bill separately. This can result in some surprises by the end of the meal – especially if the prices aren’t printed on the menu.”

Anthem Blue Cross and Blue Shield’s bundled payment agreements extend beyond the costs associated with the actual surgical procedure to also include recovery and rehabilitation services, such as physical therapy. Additional peace of mind and cost certainty is provided through a performance guarantee similar to a warranty.

“The purpose of these bundled payments is to deliver high quality care and a high quality experience to Anthem Blue Cross and Blue Shield members,” said Foley. “If any additional medical services are needed within 90 days of the surgery to make the procedure a complete success there is no additional cost to the patient, so long as they return to the doctor who performed the bundled procedure. This cost protection is completely unique to these bundled payments. In almost any other case, patients who undergo additional procedures would be subject to additional costs in the form of deductibles, coinsurance and copays, depending on their insurance policy.”

Bundled payments are reflective of a larger trend within health care that is working to align payments with the value of the care, rather than the volume of health care services delivered.

“As costs have continued to increase everyone – doctors, insurers and employers – have realized that how we pay for health care and the incentives we have in place for doctors need to be focused on helping people get and stay healthy,” said Dr. Michael Jaeger, managing medical director for Anthem Blue Cross and Blue Shield in Wisconsin. “We’re working with health care providers throughout Wisconsin to build the next generation health care system that invests in the doctor-patient relationship and promotes appropriate use of health resources. With bundled payments, the future of health care is unfolding before our eyes.”

The United States spends approximately $2.5 trillion on health care each year. Experts estimate that as much as 30 percent of that spending – or $700 billion – is the result of problems within the health care system itself, such as administrative inefficiencies, medical errors and a lack of care coordination. Bundled payments offer the opportunity for significant cost of care savings for individuals and self-insured employers that directly bear the cost of their employees’ health care claims. Anthem Blue Cross and Blue Shield’s bundled payment arrangements at Orthopedic & Sports Institute of the Fox Valley and Manitowoc Surgery Center offer a collaborative approach that is focused on providing a high quality, personalized experience for each patient, and both facilities have low infection rates and high patient satisfaction scores.

Bundled payments for total knee replacements are currently available at Orthopedic & Sports Institute of the Fox Valley and Manitowoc Surgery Center for individuals with Anthem Blue Cross and Blue Shield health insurance plans. To learn more about bundled payments, Anthem Blue Cross and Blue Shield members should contact the customer service number on the back of their health insurance identification card.

About Anthem Blue Cross and Blue Shield in Wisconsin

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Wisconsin is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.

Anthem Blue Cross and Blue ShieldScott Larrivee, 262-523-4746
[email protected]
Twitter: @AnthemPR_WI

Source: Anthem Blue Cross and Blue Shield in Wisconsin