Bundling care and not just payments

Payment bundling across primary care and specialties is inevitable and is the preferred approach by CMS to slow down healthcare spending. As the next wave of programs such as Making Care Primary (MCP) roll out, hopefully the mistakes from the earlier generations of bundled payment models are rectified and it leads to true cost reduction and quality improvements. While health systems have to get ready for this future, they still need to operate in today’s primarily FFS model. Physicians in the current FFS environment are severely burnt out and increasing revenue by increasing visits is untenable. The sad reality is even a 70% full schedule for a physician, results in an overwhelmed and underappreciated frontline healthcare team.

The answer to preparing for the future bundled payment programs and current FFS reality is truly bundling care. Team based care is known to improve patient experience by making it convenient for the patient to complete all required visits within the same day in the same location. The recent inaugural of the Jane and John Justin Institute for Mind Health at Cook Children’s is encouraging. However, this does little in terms of reducing the administrative burden for physicians. It does not reduce pajama time to a meaningful extent. While payments may become bundled, the patient experience remains unbundled, and it is a series of episodes even when grouped together in a day. Outpatient care needs to evolve into a team approach where all players involved are on the field at the same time. They need to adopt an F1 pitstop mindset where the patient’s needs are taken care of completely and efficiently without any all-around redundancy. To turn this into reality the patient visit needs to be well choreographed to ensure every skill set required is in the same room at the same time. In other words, the same extended team is responsible for the pit stop of all cars in the race! Not easy to do but should be attempted. The demand for services clearly exists as evidenced by patient access challenges and long lead times for appointment scheduling. One could argue this allows for a higher level of coding for each visit as the care provided is thorough and covers all bases.

This approach has the additional benefit of making the healthcare team provide emotional support to each other when they are all in it together. Sadly, this is much needed in the face of increased threat of physical violence and emotional abuse they are subjected to given widespread mental health issues in society.