DENVER--(BUSINESS WIRE)--A roundtable of seasoned healthcare executives at BridgeHealth, a specialized benefits management firm, today weighed in on fraud, waste and abuse, suggesting that pre-negotiated, bundled case rates can help eliminate this challenge in U.S. healthcare.
Using this approach, BridgeHealth identifies top-quartile hospitals and surgical centers – by practice, procedure and specific physician group – and negotiates with these high-performing surgical teams for episode-of-care case rates. BridgeHealth bundles the various charges for each surgery into a single discounted price. The benefits firm brings these discounted case rates to self-funded employers and membership organizations.
“With more than a decade of claims data, pre-negotiated, bundled case rates have proven successful in virtually eliminating FWA in surgical services through our network,” said Mark Stadler, chief executive officer of BridgeHealth. “To further reduce FWA in U.S. healthcare, we suggest broadening this time-tested approach to other medical services for group and individual plans in the commercial market.”
A number of industry analysts estimate the cost of FWA is up to $1 trillion annually. More than the cost of healthcare in most countries, FWA claims nearly a third of the total U.S. healthcare spend. FWA ranges from simple billing errors by providers to intentionally fraudulent billing for medical services.
“Pre-negotiated bundled case rate payments are fixed, so our network physicians and facilities are motivated to perform only services that are medically necessary, usual and customary,” said Kim Abram, BridgeHealth’s director of provider contracting. “Conversely, under the fee-for-service model that prevails today, the more services a provider bills, the more the provider is paid. Fee-for-service encourages FWA.”
Abram added that FWA is rare in BridgeHealth’s benefits model because it negotiates bundled prices only with “centers of excellence” – the best surgical teams, as rated by a nationally recognized independent healthcare quality ranking service. Just 10-15 percent of hospitals and ambulatory surgery centers nationwide qualify for BridgeHealth’s network.
Patients travel to these centers of excellence for any of 150 orthopedic, spine, women’s health, bariatric, cardiac, neurological and general procedures. Even including travel costs, self-funded employers spend 20-40 percent less for surgeries through BridgeHealth than through their managed care plans.
Founded in 2007, BridgeHealth (www.bridgehealth.com) is a bundled surgical benefit management company that offers a suite of products for self-insured group health plans to improve quality and outcomes of surgery, reduce costs and positively affect the rate of unnecessary surgery. Through decision support, a high-quality narrow network, care coordination and other strategies, clients get real savings in cost and high-quality outcomes while providing an outstanding patient experience through a facilitated process. Clients achieve very quantifiable results for themselves and their employee/plan members in a manner that integrates with their full suite of health plan benefits. BridgeHealth is headquartered in Denver, Colo.