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Proactively managing surgery costs through patient engagement, shared decision-making, and a focus on quality.
Business Introduction
“Unmanaged” Surgery Costs
Surgical procedures account for over 30% of a company’s healthcare costs.
But unlike pharmacy or radiology, surgical decisions are largely “unmanaged” with minimal patient awareness of cost, quality, or alternative treatment options prior to incurring a large surgical claim.
The Business Issue…
Surgery31%
Pharma10%
Behavioral Health
7%
Radiology6%
Other46%
Annual U.S. Healthcare Spending ($2.3 trillion)
“Clinical evidence shows that many patients undergo surgery that they would decline if fully informed and shared decision-making can satisfy physicians’ ethical obligations and reduce unwanted procedures”. American Society of Law, Medicine & Ethics“Although patients always have the right to participate in decisions about their medical treatment, using formal shared decision-making processes can be especially useful in cases where more than one treatment option is available, and no treatment is considered ‘best’ according to clinical evidence. Report of the Council on Medical service. CMS report. American Medical Association.
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Proactive Surgery Benefit Management
An opportunity exists to achieve better outcomes and lower costs by proactively engaging plan members in their treatment decisions.
Independent research shows that as much as 30% of major surgical procedures are unnecessary and could be avoided or handled in less invasive and less costly ways.
Additional studies show as much as a 20% reduction in costs when utilizing “shared decision making” leading to less invasive and less expensive alternatives to major surgery.
And when surgery is required, choosing a provider offering the highest quality outcomes for that particular procedure results is additional savings.
The Opportunity
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BridgeHealth SBMTM gains control over unmanaged surgery costs with three integrated programs:
BridgeHealth Early Indicators™ - identifying major surgical claims early in the process, when there is an opportunity to intervene.
BridgeHealth Engagement™ - providing medical education, resources and support related to treatment options and alternatives.
BridgeHealth SurgeryPath™ – providing access to providers offering the optimal combination of quality and value.
Early IdentificationEarly Identification
Member EngagementMember Engagement
Quality Network AccessQuality Network Access
The Solution
BridgeHealth Surgery Benefit Management
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BridgeHealth uses a combination of claims analyses, communications and case management to identify plan members early in the decision process.
BridgeHealth Early IndicatorsTM
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Plan Members are provided resources, education and support that enable them to make informed health care decisions.
BridgeHealth EngagementTM
Research shows that when given information on alternative treatments with similar outcomes, patients will generally choose a less invasive approach prior to surgery. (Dartmouth Atlas Report 2011)
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Plan Members that require surgery are assisted by BridgeHealth Care Coordinators to identify and access the high quality providers available within their health plan.
BridgeHealth SurgeryPathTM
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Quality Matters…utilizing highly rated providers results in lower costs, fewer complications and faster “return to work”.
BridgeHealth Care Coordinators utilize Delta CareChexTM to identify the providers offering the highest quality outcomes for the desired procedure.
In addition to identifying the highest rated providers within the plan members local area, BridgeHealth also offers access to a Centers of Excellence across the country:With case pricing that results in additional savings, andPlan provisions that offer advantages for the plan member.
The Importance of “Quality”
“Patients can improve their chances of survival substantially at high-volume hospitals
who perform the operations frequently.”New England Journal of Medicine
BridgeHealth SBMTM delivers savings two ways: By avoiding unnecessary surgeries…
when the Plan Member, after learning about treatment options, avoids an unnecessary surgery or chooses a less invasive, less costly, but equally effective alternative treatment.
By utilizing the highest quality providers… when the Plan Member, after learning about the importance
of quality, chooses an alternative provider for their surgery.
Savings from BridgeHealth SBMTM
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Quantifying the Savings Opportunity
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Proactive Surgery Benefit Management
Engage Educate Empower Higher quality outcomes
“People do not realize that their clinician does not always fully understand their preferences and values. When this happens, the clinician’s treatment recommendations may be different from what their patients would have chosen had they been give the opportunity to be fully informed”. Dartmouth Atlas Report 2010
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Gordon Larson
CMO/Executive Vice President
BridgeHealth Medical, Inc.
630-841-7566 Direct
Contact us for a free analysis of the savings a BridgeHealth SBMTM program could offer…
