The health care reimbursement model in the US has long relied on a fee-for-service system of payment for individual services, procedures, and therapies. It is a model built around volume of services provided, rather than value to the system or the patient.

In contrast, bundled payments — which some health care experts have dubbed the “new normal” in health care — create important incentives for providers to improve both the quality and continuity of patient care, as well as the overall experience as defined by the patient. Bundling requires hospital leadership and providers to calculate and assume responsibility for the cost of care, as well as the cost of any associated, preventable complications across the full care continuum.

Regardless of your area of expertise or focus, a streamlined strategy is essential to adopting and implementing new bundled payment models. The value trifecta of cost, quality, and patient-centeredness are the cornerstones of success in a bundled payment world. Determining true cost, along with actualizing a patient-centered, value-based approach in care delivery are critical to unlocking value and improving care across the continuum.

With this in mind, it is essential that all parties involved in care delivery understand how to put the patient at the center of their focus to understand the real costs of care and to craft a valuable bundling program.

How to Start

Identifying high-impact opportunities and aligning goals around a patient-centered system are essential to developing a bundled payment program that creates value for providers, patients, and families. To do this, providers must:

1. Put the patient at the center of everything you do.
2. Shadow patients to determine the current state of your care process, from the patient’s experience and perspective.
3. Align goals and identify variation in the process.
4. Identify and implement high-impact opportunities for change and improvement as identified by care providers, patients, and families.
5. Re-shadow patients to determine the success, or failure, of your efforts to improve the process.

Developing a bundled care delivery system relies on a few, simple tools. Effective incorporation of these tools into your organization’s daily work can help remove the hurdles to understanding bundling and unlock the value needed to successfully compete on a national scale.

Shadowing — observing patients and families as they move through each step in their health care journey — is a particularly important tool to redirect your focus from patient volume to patient value. Shadowing helps you get a complete picture of the current state of your care process, as directly experienced by patients, families, and providers.

Challenging Assumptions

You might think you know exactly what happens to each patient and family as they move through your care system. Few teams that have shadowed patients, however, do so without gathering some eye-opening information.

With patient shadowing, you will learn how to achieve the “value trifecta” of better outcomes and experiences of care while reducing costs by learning from patients, families, and clinician providers and co-designing improved processes with them. Past improvement projects that have incorporated patient shadowing have resulted in reduced lengths of stay, reduction in blood transfusions, reduced consumable costs, and proper discharge disposition to home rather than rehab or skilled nursing — all without compromising outcomes and experiences.

With this kind of qualitative and quantitative data, you can begin to develop your coordinated, stepwise bundle and implementation team. Without it, you risk creating a system based on false assumptions and inaccurate or incomplete information.

Continuously shadowing patients and families will not only arm you with the data needed to make critical value-based decisions that affect all stakeholders, but will also naturally engage staff, patients, and family in the co-design and improvement of any care experience.

Shadowing is the most accurate and efficient way to identify the current state of any process and then to build care maps and a bundling program that reflects the wants and needs of leadership, providers, patients, and families. Shadowing uncovers opportunities to improve care, streamline processes, and increase value across any organization. More importantly, shadowing gathers the critical data needed to understand the true cost of delivering care.

Creating a patient-centered value system is an important first step in successfully navigating bundled payment systems. The goal is to put the patient at the center of all you do.

Anthony DiGioia, MD, is Medical Director of the Bone and Joint Center and The Innovation Center at Magee-Womens Hospital of UPMC. He is also faculty for the IHI Virtual Expedition: Bundled Payments — Beyond the Basics.