Delta Joint Management LLC, a physician-owned case management company specializing in operating outpatient joint replacement bundles, launched 90-day joint replacement bundles for knees, hips, and shoulders in partnership with Blue Cross and Blue Shield of North Carolina in 2017. Delta, a third party, assumes all financial risk and liaises between physicians and payers to set payment rates and set standardized care pathways. Procedures are performed at Surgical Center of Greensboro, an Ambulatory Surgical Center affiliated with Delta's physicians.
In contrast with traditional hospital-managed bundles, Delta's bundle is physician-controlled. As a result, physicians—not the hospital—assume all financial risk over the 90-day bundle episode. Here are the three strategies that were critical to their success:
1. Select top-performing surgeons
Before implementing the bundle, Delta's physician leaders developed a selection process to determine surgeon eligibility for participation. For the bundle to succeed, Delta had to choose physicians who could consistently deliver high quality short- and long-term outcomes and keep cost variation low.
To qualify, surgeons must have completed at least 70 joint replacements per year and have a demonstrated track record of high performance on patient outcomes measures, such as complication and readmission rates.
2. Extend the lens of comprehensive case management
Delta's leadership also recognized the need to coordinate patient care during the entire treatment episode, not just during surgery, to prevent suboptimal patient outcomes and satisfaction.
Delta encouraged participating orthopedic practices to employ case managers, who streamline patient transitions at each stage of the 90-day bundle. Case managers monitor patient transitions before and after surgery, which reduces the risk of readmission. Additionally, concierge-style service aims to boost patient satisfaction throughout the episode. These enhancements aim to pay off in the form of increased patient satisfaction, and higher likelihood of word-of-mouth referrals to friends and family.
3. Deal post-acute care providers in on risk
Delta also understood the importance of a seamless transition to post-acute care in fostering rapid patient recovery without complication. To accomplish a seamless transition, Delta sets standardized treatment protocols with physical therapy and home health providers to decrease patient recovery time and reduce complications. To incentivize providers to follow these standardized protocols, the organization provides a prospective payment at the beginning of the post-acute treatment portion of the episode and reimburses at least 100% of the fee-for-service rate.
Surgical Center of Greensboro has seen volumes under the bundle increase 200% since implementation in 2017. Other payers have taken note of this success and are entering into similar arrangements with Delta Joint Management.