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Mar 21, 2019

Today we’re talking episodes of care payment models, otherwise known as bundled payments. Just to catch you up if you’re unfamiliar, this type of payment model means that a health care provider packaging together all the services needed during an episode and charges a guaranteed price for guaranteed quality of care.

If we’re talking about government payments, about 50% of, for example, knee surgeries are paid for right now in an episode of care fashion. In the private pay landscape, that number is lower but growing.

Bundles have advantages to purchasers (ie, employers or taxpayers who are the ultimate payers) because it’s possible to predict and compare the target price they’ll pay. But it’s also important for consumers who are partial payers in most cases. Bundles make health care prices transparent in a way that fee for service (FFS) can never manage.

Today I speak with François de Brantes, senior vice president at Remedy Partners and a noted expert in episodes of care and bundled payment initiatives. François also actively supported the launch of the Leapfrog Group, created Bridges to Excellence, and led the development and implementation of PROMETHEUS Payment.

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François de Brantes is senior vice president of commercial business development at Remedy Partners. He has spent nearly 20 years advocating for, and working to transform, the US health care system by improving incentives for providers and consumers to encourage value-based decisions. Prior to joining Remedy Partners, he was executive director of the Health Care Incentives Improvement Institute (HCI3), a not-for-profit company that designed programs to motivate physicians and hospitals to improve the quality and affordability of health care delivery. Early in his career at General Electric, he was involved in many strategic programs that rewarded providers for better performance. He has written extensively about the topic, including his 2013 book, The Incentive Cure: The Real Relief for Health Care.

02:04 The new Medicare Shared Savings Program (MSSP) and how it intersects in this conversation.
03:02 Why physicians need an advanced alternative payment model.
04:01 Why episode of care makes sense.
04:40 Why upside-only deals are not financially sustainable.
06:16 A manageable financial risk.
07:34 Taking on total cost of care and the small percentage of significant potential variability.
08:37 “The only way to avoid the almost-certain variability that is going to accrue on that half of 1% is if you have a lot of patients.”
09:12 The “danger zone” of Medicare beneficiaries.
11:55 “Either you’re in total cost of care, or it’s episodes.”
13:59 Quality of care vs bundled payments.
18:20 “Let’s not forget … that the reason why we’re doing … this … is because consumers, directly and indirectly, are paying the price.”
19:00 Dave Chase’s books and health care in the middle class.
19:42 The wealth of savings in post-acute care.
21:19 How to demonstrate the value you’re bringing to that episode of care.
21:47 Broad strokes of integrated delivery systems that provide value.
22:08 The next logical solution in integrated delivery systems and episode of care payment programs.
22:28 “They’re going to take on much more of the role of the care coordinator.”
23:43 “It’s not just the integrated systems; it’s really the physicians who … are taking responsibility for what happens.”
24:00 Michael Hunt and formalized, evidenced-based ways to evaluate post-acute facilities.
24:22 Remedy Partners and François’s role in episodes of care.

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