Maximizing Value: Are you ready for bundled payments?

Morant: Quality improvement is a key part of making a bundle payment work well for an academic medical center. Hi, I'm Dr. Helen Morant. I'm the clinical education specialist for BMJ in North America.

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Jolley: This is Dennis Jolley with University of Utah Health Sciences, and I'm here with Dr. Helen Morant. Helen, thank you for coming so, let's start out with BMJ and the partnership with AAMC. You are just launching a new program here at the conference?

Morant: That's right. Double AAMC approached us about a year ago to see if we would be interested in a partnership to distribute some of the information that they are gathering as part of their BPCI project on bundle payments. So they're working with 10 large academic medical centers who are the pioneers in introducing bundle payments as academic medical centers.

And they're collecting, over the course of the work they've been doing together, they've collected a huge amount of information and wisdom about how payment reform can affect hospital delivery systems and improve quality. So the learning modules we've made at BMJ site have been using that content and we are making available for other institutions to learn from that wisdom and see if they are ready for payment reforms.

Jolley: So how do you know if your hospital is ready to start considering bundle payments?

Morant: No one really knows, and so we've created a Readiness Assessment tool which is freely available for anyone to take. And we want loads of people to take this quick survey. It's like a few quick questions that you can do online at the maximizing value site which is the maximizingvalue.bmj.com. And the survey will give you a personalized, but automated response. Straight away you'll get a score in the different areas like governance, quality improvement, IT systems. We ask you what you know about those things. Even if your answer is I don't know that's a good sign to suggest you might not be ready.

Jolley: It helps direct people to getting back to getting more information.

Morant: Yeah and so the report you get will give you a links to resources both on the maximizing value site but also other resources are available.

Jolley: As you are working with your partner hospitals what are these key areas? You identified for example, IT, what are some of the other areas?

Morant: One of the big things to just come up is cost and understanding what your costs are and the thought that we don't know exactly how much it costs us to provide health care in the U.S. because it's the math is done with the payers and it costs a lot of money.

Jolley: It's a little bit of a black box.

Morant: It's a black box and so the hospitals that have been pioneering this have been doing some really detailed work using quality improvement techniques, like lean and six sigma to really get in-depth with the process mapping and really unpick, so hour by hour or even minute by minute what it costs to deliver care in the way they're currently doing it and therefore, look for improvements in the way they can do it. So quality improvement is a key part of making a bundle payment work well for an academic medical center.

Jolley: What are some of the other elements?

Morant: Your IT systems are important and understanding your electronic health record is a key part of making sure that the right participants in the care process have access to the right information. And the other key area we are finding is care transitions and where patients are handed off within the clinical environment but also for their rehabilitation. Whether they go home, whether they go to a skilled nursing facility and the communication and the information exchanges at those transitions of care are incredibly important. And people aren't necessarily aware of that until they are really looking to that processes.

Jolley: It really sounds like readiness for bundle payment and bundle payments only can come in if your hospital has really done a lot of work around these processes, collaboration, knowing costs, getting the right systems in place and really starting that transformation even ahead of payments?

Morant: Yeah absolutely, and I think the initial bundles have been speaking at a couple of sessions here and the hospitals doing the work have found the work incredibly useful across their systems, in they're creating these bundle payments around specific conditions like cardio valve replacement or arthroplasty.

But the questions they are asking themselves and the direction of quality improvement that going through the processes is forcing them into, is improving the quality of care generally throughout the hospital. And the preparing for the bundle payments whether or not that becomes the predominant payment method is really useful in improving care in the hospital.

Jolley: And that's good for everyone?

Morant: Yeah, absolutely.

Jolley: So can you give me one example of one of the things that your site provides outside of the Readiness Assessment?

Morant: It's free you can go straight in and we're providing as well as that two key elements of maximizing value. One is the e-learning tools. And the idea of e-learning which is our area of expertise and particularly mine is what is fantastic is bringing everyone up to a level of knowledge without spending huge amounts of classroom time and resources in teaching. And e-learning is incredibly important for getting a lot of people in the institution aware of what they should be doing and aware of bundle payments and what it means for them. So you've got a suite of e-learning modules which are interactive and fun. And it can be a dry subject, some of the risk sharing and finance, believe you me, but we've got some really interactive graphs that you can click on and feel engaged you can test yourself with CME accreditation as well.

Jolley: Making value fun.

Morant: Making value fun yes, we haven't used that strapline, I don't know why. But the other part of it is quality improvement and we've got a project quality tool box which helps people go through a quality improvement project, holds their hand, make sure it's a publishable and shareable standard so that you can share what improvements you're doing with your institution, with the other teams in your institution, with other teams in the U.S., with similar organizations in the U.S and even globally as well because we can publish those quality improvement reports.

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