across an episode is coordinated to improve quality at an overall
reduced price," says Dr. Gonzales. "By looking at how to control all
the costs in the episode, not just at the [surgical] facility, you can gain
from some of the savings the payer recognizes by the patient's overall
care being less expensive."
Don't cut corners in order to save money, warns Dr. Gonzales,
because payers aren't just looking to lower costs — they also want
higher quality of care. Complications, revision surgeries and infections
can run up costs and wipe out profits in an episode. "If you avoid a
wound infection or a contracture, and make sure the patient has good
range of motion and is really progressing well with their functional
scores, then in theory that should result in overall less cost, and the
patient's happier," says Dr. Gonzales.
Payers often award preferred status to providers they believe deliv-
er high-value care, says Dr. Gonzales. "A provider may come in under
budget, but their quality outcomes might not be good, which could
indicate they're meeting their budget by underutilizing care. Then
their opportunity to become a preferred provider and get additional
volume starts to suffer."
Seek out providers of outside services who are interested in deliver-
ing value-based care. Although Excelsior runs every element of the
episode of care, the bundled payments Dr. Uba negotiated with local
payers includes some financial wiggle room if they need to contract
with external providers.
"We have that flexibility in the bundle, as long as everybody's
motives are aligned," he says. "You need reasonable people who aren't
fighting over a dollar. You need the right people around the negotiat-
ing table with the right motivations, [getting involved in joint replace-
ment care] for the right reasons, not as a money grab."
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