Bundles: Driving Volume and Predictable Pricing

1. PackagesEpisodesBundlesOH MY! Deb Lauricia, Senior Director Strategic Initiatives, Revenue Cycle February 16, 2017

2. Agenda • Who we are • History of bundling at Cleveland Clinic • Current initiatives • International arena • Challenges • Where we are headed

3. FRANK E. BUNTS, MD GEORGE CRILE SR., MD WILLIAM E. LOWER, MD JOHN PHILLIPS, MD Since 1921A Unique Model of Care • Four doctors share a vision • Non-profit, physician-led group practice • Collaboration across disciplines • All physicians are salaried • Patient-centered mission

4. Cleveland Clinic Today • 49,000 caregivers • 6.6 million total visits • 164,000 hospital admissions • 3,400 physicians & scientists • 1,888 residents & fellows

5. 2016 Cleveland ClinicU.S.News & World Report • #1 in Cardiology & Heart Surgery; 22nd consecutive year • 9 specialties ranked in top 3 • Ranked in 14 specialties • Cleveland Clinic Children’s ranked in 9 pediatric specialties

6. Bundling • Specialty Medical Care Program • Began 20 years ago as means to drive volume and provide predictable pricing • Includes both the professional and technical services for a single encounter • High end inpatient • Small provider networks and large payers

7. Bundling • Program for Advanced Medical Care • Expanded to include additional procedures and chronic conditions • Broad based commercial contract offering • Local Employers • Limited outpatient

8. Episodes • Transplants • Includes pro and tech • Multiple payment methodologies • Phases • Flat rates • Fee for service up to maximum reimbursement

9. Episodes • Time Based • Fixed period of time • All related services • Pro, tech, ancillary, etc • Single rate, single authorization • Direct to Employer business

10. Episodes • Clinical Based • Defined clinical pathway • Retrospective • Medicare BPCI • Cardiac Rehab • Comprehensive Joint Replacement CJR • Ohio Medicaid State Innovation Models

11. Population Health • Patient Centered Medical Home (PCMH) • Medicare Accountable Care Organization (ACO) • Comprehensive Primary Care Plus (CPC+) • Package additional services into standard care • IE: Chonic care management, outreach, etc.

12. International • DRG based bundles • Other services percent of charge • Self pay, Embassy, International Payers • Moving to clinical based

13. Challenges • Patient Identification • Registration issues • Manual claims process • Partnering with vendor for automation • Payment reconciliation • Small volumes • 292 cases / $21.5M

14. Future State • Clinical Guarantees • CPC+ Management • Expansion of clinical bundles to commercial business • Prospective • Specialty Bundles: TAVR • Employee Health Plan Pilots • Gain Sharing

15. Take Aways • Find what you do well and start there • Map your clinical process • Prepare for data, a lot • Insource vs Outsource • Patient identification is critical • Build a strong front end, lock it down • Resource for a manual billing flow • Technology is advancing • Create a process to handle the outliers • Reconcile, reconcile, reconcile