The Change Agent Chat Series is a collection of interviews with boots-on-the-ground organizations and individuals working to advance lower cost and better care for all Coloradans. Join us on the 4th Friday of every month from 12-12:30pm MT.
On April 28th, 2017, CIVHC's CMO, Jay Want, sat down with Colorado PERA’s Executive Director, Greg Smith, to discuss the PERACare Select program that bundles hip and knee replacements into one payment.
What makes the bundled payment program important?
It is easy for participants to take advantage of the service. CO PERA handles all of the different bills associated with a procedure; giving the members a clean experience.
CO PERA does not tell members where to get services but with the PERACare Select program, they are trying to steer them to a location where they will get excellent care at a pre-determined price.
How does it work?
The program is available to all members, they just need to see one of the providers in the PERACare Select program – no need to sign up, and the provider handles the rest.
If the member chooses to use the PERACare Select providers, CO PERA waives all copays associated with their procedure. From pre-op through check-in to check out, members receive no bill.
Physical therapy is not part of the package currently, to enable members to receive this service near their home.
PERACare Select has specific participating providers, how do members know they are going to receive quality care?
Low cost care does not always translate to low quality care.
The providers who entered the partnership are those who are experts at these procedures. They agreed to perform the services at lower prices because they know they can do it without complications and infections that drive up costs.
Having limited providers helps CO PERA negotiate the program, the value-add to the providers is additional volume of procedures.
What have you heard from patients? Are they satisfied with the providers?
CO PERA does a lot of follow-up with patients after the procedures, and most patients are happy with the experience. No infections or readmissions have resulted from any of the surgeries performed to date.
Some members have actually undergone the procedure earlier than they would have without this program, which helps increase their quality of life by allowing them to remain active.
How many have opted into the program?
The program has only been around 18 months, and in 2016 132 hip and knee surgeries were performed for CO PERA members and 49 of those opted into the PERACare Select program.
One of the biggest challenges is educating people about the program and letting them know it exists before they go too far down the path of selecting a provider.
What savings have been realized?
Compared to the average cost for the same surgeries outside the program, CO PERA saved about $580,000 with the 49 members who did opt in.
Members save anywhere from $10,000 - $12,000 depending on whether they have met their deductible.
Coming in May:
- Sixty-eight percent of adults with mental illness have one or more chronic physical conditions.
- Additionally, individuals with serious mental illness are less likely to seek medical care, preventive care, and have high rates of smoking, obesity, sedentary lifestyle, financial, insurance and food insecurities.
- Finally, more than one in five adults with mental illness have a co-occurring substance abuse disorder.
It may seem like these patients are at the center of a perfect storm, but with thoughtful, coordinated, and customized care, providers can help them steer toward clear weather.
In the Chambers Hope Health and Wellness Clinic, Colorado’s Aurora Mental Health Center has created a shelter from the storm. In collaboration with their Federally Qualified Health Center partner, Metro Community Provider Network, the clinic provides highly integrated primary, behavioral health care and comprehensive wellness to Aurora residents.
How do the teams at Chambers Hope integrate these disparate types of care? What is the greatest challenge they have faced with their population? How have patient outcomes improved since the clinic opened?
Join us during lunch on Friday, May 26th when CIVHC’s Chief Medical Officer, Jay Want, MD chats with Lauren Tolle, Ph.D., Division Director for Integrated Care at Aurora Mental Health Center and Margie Kaems, LCSW, Clinical Social Worker and Program Manager of the Hope Health and Wellness Clinic and the Mobile Heart Health Project.
Engage in the conversation by writing in additional questions during the discussion.
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