Spine Surgeon Talks Benefits of Affiliation with Blue Shield, Global 1

By Scott Leggett

Like most doctors, Brian Perri, DO, a spine surgeon practicing in Beverly Hills, Calif., is challenged to provide the best care for his patients while helping patients and payers control the costs associated with acute surgical procedures. Dr. Perri employs three key strategies to assure his patients get the best surgical care with the best outcomes at the best price.

First, Dr. Perri went in-network with Blue Shield both professionally and with his affiliated surgical facility. This affiliation with Blue Shield gives him access to the Global 1, or G1, bundled payments program, a recently established partnership between Blue Shield and Global 1, a California Third Party Administrator (TPA).

“I am now in-network from a professional standpoint; we can now accept all Blue Shield patients through the Global 1 program,” Dr. Perri said.

Next, he shifted appropriate surgical cases from higher-cost hospitals to ambulatory surgery centers (ASCs). This has allowed Dr. Perri to continue assuring that his patients receive the best care with optimal outcomes while reducing the overall cost of care.

“We can perform nearly all spine surgeries at our surgery center provided the patient is healthy and covered from an insurance standpoint,” said Dr. Perri.

Finally, Dr. Perri embraced contracting for surgical services using pre-negotiated bundled rates. This allows Dr. Perri to manage and direct the bundled payment process while ensuring his patients or their insurers make one payment for all related episode-of-care costs.

“The bundled payment that is proposed to the patients covers everything,” noted Dr. Perri.

The result: happy patients, less administrative red tape and a streamlined administrative process.

“This is a much better experience for both the doctor and the patient,” observed Dr. Perri of the Blue Shield/Global 1 bundled payments program.

“There is very minimal administrative interference with patient care. It is more of a one-on-one and personal interaction with much higher patient satisfaction scores,” Dr. Perri said.

“The Global 1 approval process is very straightforward,” he added.

Dr. Perri’s engagement with Blue Shield, Global 1, ASCs and bundled payments reflects Blue Shield’s recognition of emerging opportunities to make a meaningful impact on rising healthcare costs. These opportunities include:

  • Contracting with providers for surgical services using pre-negotiated bundled rates.
  • Allowing its surgeons to quarterback the bundle payment process.
  • Shifting appropriate surgical cases from higher-cost hospitals to ambulatory surgery centers (ASCs).

From a marketplace perspective, Blue Shield recognized the opportunity in bundled payments: Combining professional and technical allowances into a single rate would help stabilize the wide variation in payments while paying providers a fair rate.

Blue Shield understood that administering such bundles in a conventional claim system would not be possible and building a unique ASC network of surgeons would require a partner.

As such Blue Shield chose to partner with Global 1, a California TPA, whose principals had a long and successful history in managing ASCs and managing bundled rates for commercial patients from the medical travel space.

The program is now officially in its fourth year and continues to expand. For example, plans are in place to implement an additional patient benefit in January 2019 by lowering the patient co-insurance when using an ASC setting for surgical services.

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With over 100 surgery centers and 600 surgeons in the statewide network, the Blue Shield California (BSC)-Global 1 bundled payment program is going strong with many plans to expand. If you would like to learn more about the program for you and your BSC patients, please call Joy Houle at Global 1 to obtain more information, (760)602-7872.

Scott Leggett is co-principal, Global 1 and managing director, Convergent SameDay Orthopedic Strategies. With more than two decades working in orthopedics, Leggett’s experience includes founding a network of independent, physician-owned outpatient surgery centers. In addition, he served as the president and board member of the California Ambulatory Surgery Association (CASA). Contact Leggett at info@GlobalOneVentures.com or 760-494-9211.

Global One Ventures (Global 1) is a California-based, licensed third-party administrator (TPA) dedicated to developing and administrating an innovative medical payment and delivery system through its network of providers. With more than 10 years of experience, the focus of Global 1’s bundled payment structure is to deliver innovative, cost-effective surgical services that result in increased transparency, lowered costs and improved medical outcomes in an outpatient setting. For more information, visit: g1surgery.com.

Convergent SameDay Orthopedic Strategies is a full-service consulting company delivering contracting expertise, clinical education, process infrastructure and coaching in support of successful outpatient joint replacement programs. For more information, visit: convergentortho.com.

Looking Behind the Headlines, Physicians Find Good News in the Implementation of U.S. Healthcare Policy

By Tom Wilson

Physicians reading the news about U.S. healthcare policy may wonder about the fate of their profession amidst the backdrop of highly-charged healthcare policy debates in Washington, D.C., and attendant media coverage often focusing on the political stories rather than the practical realities of delivering medical care to patients.

Behind the headlines, behind the political battles, behind the avalanche of media coverage, there are reasons for physicians to feel encouraged by actual healthcare policy implementation.

Health and Human Services Secretary Alex M. Azar II, in a recent speech, outlined an aggressive agenda intended to speed long-standing efforts to reform healthcare by empowering the consumer, improving transparency, encouraging innovation and challenging vested interests. In the details of this effort is very positive news for independent physicians.

Azar, speaking before America’s Health Insurance Plans meeting in March of this year, laid out his agenda with a focus on four areas of reform. They include:

  • Giving consumers greater control over health information through interoperable and accessible health information technology.
  • Encouraging transparency from providers and payers.
  • Using experimental models in Medicare and Medicaid to drive value through the introduction of market forces into healthcare, shifting control from large healthcare systems to the consumer.
  • Removing government burdens that impede this value-based transformation.

For independent physicians, each of these four focus areas has important implications.

Health Information

Giving consumers greater control over health information means, in part, that consumers will take possession of their own electronic health records, carrying their EHRs with them on their nearly ubiquitous mobile devices, or making them available via downloads at the request of a patient.

“Patients ought to have control of their records in a useful format, period. … [T]he healthcare consumer, not the provider, ought to be in charge of this information,” Azar noted.

Having healthcare records in a pocket or purse will open new options for patients, driving healthcare consumerism and empowering consumers to shop for and evaluate healthcare services. With almost every consumer facing significant out-of-pocket expenses associated with any major healthcare event, it is inevitable that healthcare consumers will focus on cost management in healthcare, just as they do in every other aspect of their economic lives. Recognizing this, Azar pragmatically advocates aligning policy with the technological and financial realities of modern healthcare consumption.

According to Azar, unless this technology is in the hands of consumers, “the benefits may never arrive.” Further, Azar noted, “[E]mpowering consumers and individuals has been key to the advances of the Information Age.”

Supporting healthcare consumerism is seen as a means of controlling and driving down unsustainable healthcare costs, just as consumerism has had the same effects in other market sectors.

Transparency

Here Azar is equally direct, stating, “I believe you ought to have the right to know what a healthcare service will cost — and what it will really cost — before you get that service.”

Consumers know with certainty what they will pay for goods and services in every other area of their lives, save for healthcare.

Recognition of this reality by forward thinkers in the greater healthcare community, including physicians, insurance companies, regulators, payers and thought leaders, has led to the successful creation and implementation of bundled payments as a means of providing complete episode-of-care services to a patient for a predetermined fixed price, provided to the patient prior to the outset of care.

While there are ongoing efforts to promote across the board price transparency in healthcare, bundled payments remain the only proven, reproducible packaging of healthcare services that provides true transparency for consumers.

Experimentation

Here, Azar is most clearly intent on unlocking larger market forces to drive down healthcare costs.

“We want to move to a system where we can be agnostic about ownership structures, a system that will allow independent providers to group together to drive innovation, quality and competition,” Azar noted.

The key here for doctors is Azar’s support for independent physicians and organizational flexibility that supports innovation, which in turn yields higher quality and drives competition to lower healthcare costs overall.

In the end, such an effort will yield value to the marketplace.

Azar intends to power this change with the financial and regulatory clout of Medicare and Medicaid. Here physicians can expect experimentation that will touch them directly with new payment and incentive models, reduced regulatory burden (already under way with MIPS) and incentives to streamline and improve the effectiveness of electronic health records and the sharing of health records with patients and other providers.

Finally, Azar wants to ease the collection of outcomes data and open the way for sharing that data to inform innovation and engage consumers with meaningful, relevant, timely healthcare metrics they can employ in their own healthcare decision making.

Government Burdens

“The fourth key engine for transformation,” Azar noted, “[is] addressing any government burdens that may be getting in the way of integrated, collaborative and holistic care for the patient.”

This call for deregulation may be most welcome by physicians, who, as a group, have been the focus of increasing regulation by both government and payers in an effort to control healthcare costs at the point of care.

Among the four proposed focus areas, the easing of the regulatory burden on physicians may be the most welcome of all.

Change Is Coming

According to Azar, the administration will not be deterred by special interests as it moves to implement marketplace changes to drive down the cost of healthcare.

As he noted at the close of his speech, “Change represents opportunity, and I exhort all of you to take advantage of the opportunities represented by what I’ve discussed today. Because I assure you: Change is possible, change is necessary, and change is coming.”