Editor’s Note: This publication first appeared on Premier’s website.
In the transition to value-based payment models, healthcare providers are starting to see positive results as they learn and build the capabilities and partnerships needed for future economic viability. One such model that the Centers for Medicare & Medicaid Services (CMS) launched in April 2016 is aimed at achieving higher quality care at lower costs for joint replacements. Deemed the Comprehensive Care for Joint Replacement (CJR) program, this specialty value-based payment model has shown promise.
The CJR model is significantly reducing healthcare spending while improving quality.
A national survey and study of 104 surgeons found that those participating in the CJR model had significantly greater use of practices aimed at improving post-discharge care. This included developing narrow networks of high-quality post-acute care providers, using telehealth services and reducing unnecessary utilization of skilled nursing facilities (SNFs) among surgeons practicing in CJR. These analyses are consistent with other studies that find that bundled payments create incentives to invest in identifying high-quality and effective post-discharge care to more effectively manage costs. Additionally, a NEJM study found that the mandatory CJR bundled payment program achieved a 3 percent reduction in spending for hip and knee replacements over a two-year period.
Premier® members participating in the CJR program are also seeing positive results and have consistently outperformed their peers by 30 percent in achieving savings payments. These cost savings were achieved while maintaining or improving quality, measured by their “excellent” quality scores. Premier CJR participants have noted reduced unnecessary utilization, the introduction of enhanced care management for lower extremity joint replacement (LEJR) patients and fewer complications following procedures.
With millions of dollars in cost savings, the CJR program is significantly reducing unnecessary healthcare spending for the federal government, while generating a new source of revenue for participants and, most importantly, providing better, more coordinated care for patients. However, as with other value-based payment programs – especially those pushing providers to assume more risk – there is room for improvement. Continue Reading >>
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