Programs and Services

SMG’s bundled payment management team is experienced at developing, implementing, and managing successful bundled payment programs. Our team is available for both individual and comprehensive services. We are experienced in episode management which is a practice in healthcare providing services as well as care coordination for a patient for a particular healthcare need during a specific period of time. The goal of episode management aligns with bundled payments because the entire process and work flow focuses on individual patient needs. This care philosophy is in direct contrast to the fee-for service payment system that often provides a cookie cutter approach to patient care and often more unnecessary services. 

SERVICES

We assess a Client’s current and potential bundled payment engagement utilizing SWOT and GAP analyses to guide specific recommendations. GAP and SWOT analyses will cover the following areas for orthopedic bundled payments:

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Strategy

  • Overall strategies related to value-based payment, population health, ACO/MSSP, Medicare Advantage, other risk arrangements, total cost of care programs, pay-for-performance and bundled payments including BPCI and CJR.
  • Value proposition to patients, community, physicians, provider partners and hospital

Infrastructure

  • Technology
  • Staffing

Care Redesign

  • Pre-op, acute and post-acute pathways and protocols
  • Risk stratification

Physician Alignment

  • Gainshare and/or co-management arrangements
  • Physician relationship and engagement

Post-Acute Care (PAC) Network

  • Preferred and non-preferred network
  • Protocols/pathways for IRF, SNF, HHA and OPT

Analytics and Reporting

  • Current analysis and reporting
  • Analysis for strategic decision making

Training and Education

  • Platform for onboarding and continuous improvement
  • Education program for administration, physicians, case managers, hospital staff, nurses, PAC providers, mid-level and patient and caregiver.

Community Resources

  • Beneficiary incentive waivers
  • Current network and resources (internal and external)

DELIVERABLES

We will provide the Client with a written assessment and analysis of the current state of Client’s bundled payments, opportunities, areas for improvement, and recommendations on steps to improve Client’s bundled payment program.