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So another model that the state of Minnesota has developed is what they refer to as the Baskets of Care.
Their permanent rules just went into effect this past March, 2011. Their process was a long one, it took over two years and...
...it involved a steering committee that included health care providers, health plans, consumers, expert ...
...organizations and other stakeholders that have experienced working with the clinical groups. In the development of what goes into...
...each of the basket that they created was carefully vetted subsequently through an extensive stakeholder...
...in an expert process. The baskets that they have developed define the scope and the set of care for a condition or...
...a procedure or episode. The state only put forth the specific contents of each basket and some basic rules about...
...the implementation. But they didn't define the payment structures or the bundles. Instead, providers and payers simply agree upon...
...a payment for basket in advance through a negotiation process and the payers then will make that basket available to their...
...beneficiaries. There are also quality measures that are built into these baskets of care that are predefined with each basket.
And the providers are required by the Department of Public Health to submit quality measures for each basket if they participate.
So the way that this payment model works is that the basket owner submits the claim to the payer and the additional...
...providers submit what they call encounter data not to be used for payment purposes. The payment then flows from...
... from the payer to the basket owner, the coordinating provider, who then pays the other service providers that might...
...be affiliated with that basket. They have developed eight different baskets - some of them chronic diseases...
...few acute procedural episodes including pediatric asthma, diabetes, pre-diabetes, lower back pain, obstetric care, preventive care...
...which is the primary care assessment referrals and total knee replacement. As I mentioned, the calculation is based on a predefined...
...negotiated payment between the payer and the basket owner as it's purchased by the consumer.
The last model that I will provide some detail on is the Geisinger Model. This is an example of a model that's in a ...
...fully integrated payer provider group. Geisinger is a group of about 700 employees and physicians who provide primary care and...
... specialty care along with three acute hospitals, several ambulatory surgery centers, and specialty hospitals...
...and a health plan with more than about 200,000 members that are located in Pennsylvania. They took standard treatment protocols...
...and translated them into best practice elements that must be adhered to by those providers.
The payment includes the pre-procedural work-ups, the hospitalizations, the professional fees and any ongoing post-discharge follow up and...
... management of the care that's associated with the services. The providers are paid a flat fee...
...for the services that were delivered from the time of notification of the event or of the needed surgery...
...through ninety days after the event. In this case, we are actually talking about Coronary Artery Bypass Graft (CABG) surgeries.
Geisinger began with coronary bypass graft surgery and then expanded the program to include some other episodes...
...like hip replacement, cataract surgery, angioplasty, bariatric surgery, perinatal care and low back pain.
The calculation of the payment rate is a single packaged rate that's based on best practice services...
...that are included in the care. This also includes 50% of the average readmissions costs that are calculated from a...
...two year lookback historical data for a comparison group across all similar episodes. So, that's equal to sort of the PAC allowance in the Prometheus model...
...Something not listed here is that they also built in what they called a patient compact, which is a joint...
...Geisinger patient agreement that emphasizes the importance of the care ownership both between Geisinger and patients and...
...as well as their families. As I mentioned through out this process, there is a great deal of detail that is presented in the Bundled Payment Volume I report...
...on these models as well as a few additional models, like the Integrated Healthcare's Association (IHA's) pilot that is just begining and the Medicare Acute Care...
...Episode (ACE) demonstration. And we also take a look at some episode group or software not full bundled payment methodologies...
...if you will; but, it allows the grouping of clinically related services together. So I encourage you to take a look...
... at that report when you have time and you will find that available on our website.