CaroMont Health and BCBSNC Announce Innovative Health Delivery Initiative: Bundled Payment Program for Knee Replacement

GASTONIA, N.C., March 22, 2011 /PRNewswire/ -- CaroMont Health and North Carolina's largest health insurer, Blue Cross and Blue Shield of North Carolina (BCBSNC), announced today a collaborative arrangement to offer patients a new health care delivery and reimbursement model for knee replacements. This innovative, value-based initiative is designed to provide quality care with improved care coordination at competitive pricing.

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The CaroMont Health and BCBSNC bundled payment arrangement is based on the PROMETHEUS Payment model and will cover the entire knee replacement, including the pre-surgical period of 30 days prior to hospitalization, the surgery itself, and most follow-up care within 180 days after discharge from the hospital. An early April implementation date is planned.

Betty Herbert, CaroMont Health's Director of Managed Care, described the arrangement, "This program will cover a variety of Blue Cross Blue Shield North Carolina plans and extends nationally to all Blue Card members. This allows us to offer value-based, quality care on a national level. Additionally, the initiative includes a number of features that promote care coordination. Specific quality and patient satisfaction measures are built in to the plan because we wanted the patient's needs to guide our program."

The bundled payment arrangement does not apply to federal employees covered by BCBSNC or to customers with BCBSNC Medicare plans.

This program is part of CaroMont Health's move to become an Accountable Care Organization. CaroMont Health is focused on responding to economic challenges and health reform legislation by meeting patient needs. The strategy includes partnering with local employers and payers to institute cost-effective initiatives that cover both hospital and physician services for a full episode of care.

"Collaboration with providers that eliminate fragmentation in the way care is provided and paid for – and promote better outcomes in the process – is our priority at Blue Cross," said BCBSNC President and CEO Brad Wilson. "We believe initiatives like this one at CaroMont are key to promoting health care quality, while also holding down costs."

CaroMont Health President and CEO Valinda Rutledge said that this initial program is likely to lead to other collaborative opportunities. "Our collaboration with Blue Cross and Blue Shield of North Carolina for the knee replacement bundle is paving the way for us to redesign the delivery of care for other diseases and procedures," Rutledge said. "The possibility exists to redesign entire episode of care programs for chronic diseases. We are passionate about providing quality health care at a reasonable price for our community, and this arrangement is an example of our success."

Physician practices participating in the program include Carolina Orthopaedic and Sports Medicine Center, P.A. and Gaston Anesthesia and Pain Management Associates. Dr. H.C. Thomason with Carolina Orthopaedic and Sports Medicine Center, P.A. is pleased with the collaborative spirit of the program. "As health care delivery models change, community-based physicians need to work together with hospitals and insurers around a central theme of care coordination. In this program, we have aligned ourselves by asking the question: "What is best for the patient?"  We've answered that question with this arrangement."

In order to successfully launch this initiative, CaroMont Health partnered with GE Healthcare and Sg2 analytic experts to assess the cost of a full knee replacement episode of care, including the pre-surgical period, surgery and post-surgical period. This extensive analysis included observations and interviews with key members of the CaroMont Health clinical staff to redesign the care pathway and quantify the financial impact of the redesign through unique simulation modeling recently developed by GE Healthcare for this program.

"The real national excitement is in our ability to provide a price to the payer for the entire episode of care," said Jeff Moser, Vice President at Sg2. "By looking at costs across the full episode of care, we are able to demonstrate care redesign for every step of the process—pre-surgical, the surgery itself, and post-surgical.  Now, with the CaroMont and BCBSNC new knee replacement bundled payment program, CaroMont will be able to include post-surgical episode costs. The goal is to ensure effective use of resources, improved clinical outcomes, cost-effective care and, ultimately, a better patient experience." 

About CaroMont Health

CaroMont Health in Gastonia, North Carolina is a regional, independent, not-for-profit health care system and nationally-recognized "value-based" health care provider. CaroMont Health is the only hospital in the region named by Thomson Reuters as a 100 Top Hospital for quality care and is one of two HealthGrades' Clinical Excellence recipients in North Carolina. CaroMont Health is among an elite group of 19 selected participants (out of 3,000 national hospitals/systems) engaged in demonstrating "Accountable Care Organizations" (hospitals focused on accountability for highest outcomes at the lowest cost for individualized patient care). CaroMont Health also is among a select few hospitals to be granted affiliation with Columbia HeartSource of New York—a clinical partnership that provides patient access to world-class clinical guidance and research trials. CaroMont Health has received numerous quality awards and is among only 6 percent of national hospitals to achieve Magnet recognition status for nursing excellence from the American Nurses Association. CaroMont Health System encompasses Gaston Memorial Hospital with 435 beds; Courtland Terrace, a 96-bed skilled nursing community; Gaston Hospice, which includes the inpatient 12-bed Robin Johnson House; and CaroMont Medical Group, a extensive network of primary and specialty physician offices and nearly 200 employed physicians. CaroMont Health is proactively engaged in achieving its vision: To be a nationally-recognized leader and valued partner in promoting individual health and vibrant communities. CaroMont Health employs 3,800 health care professionals, including a medical staff of 455. CaroMont Health is located at 2525 Court Drive in Gastonia, N.C. and can be reached at 704-834-2000. Additional information is available at www.caromont.org.

About BCBSNC

Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 77 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at http://www.bcbsnc.com.

SOURCE CaroMont Health