Deirdre Baggot: At the Forefront of Managed Care Innovations

A big part of keeping health care costs down is finding better ways of delivering care. The Affordable Care Act (ACA) has provided coverage to more people than ever before, but it has also created a huge amount of paperwork. Medical industry business strategist and RN, Deirdre Baggot is at the forefront of finding ways to streamline payment systems and increase health care efficiency without shortchanging patient services. One of the methods she’s devised is a bundled payment system.

What Are Bundled Payments?

The current billing model for government supplied health insurance is to bill each service separately. By bundling payments, insurers and patients receive one bill with accumulative billing information for all delivered services. This process was rolled out in stages to ensure a smooth and seamless transition, first for end-stage renal disease patients, and then in a mandated billing protocol for orthopedics as a Comprehensive Care for Joint Replacement (CJR) model. It is also being tested in oncology with a grant to develop an Oncology Care Model (OCM). View to learn more

The fund estimates savings of up to $19 billion by 2019.

How Do CRM Bundles Work?

It takes some preparation to implement any new system. The smaller the steps, the easier it is to work out the kinks before full implementation. Practices are encouraged to take a methodical approach prior to switching over that includes six steps:

– Set benchmarks for clinical and cost performance

– Build-in cross-continuum management capabilities

– Understand what drives cost at the post acute stage and build-in measures to establish aftercare protocols in advance

– Develop a monthly review system to consider cost and quality of service

– Create a comprehensive program to reduce readmissions

– Perform reviews to identify problem areas and use the analysis to improve bundling protocols moving forward

Thee steps should work for any kind of practice, but they will be especially beneficial for specialist practices like cardiology, orthopedics, and cancer treatment.

Streamlining billing processes means less time spent doing paperwork and more on patient care. It not only improves efficiency, it means quicker reimbursement for doctors and less hassle for patients.



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