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 G1, 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 G1 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/G1 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 G1 approval process is very straightforward,” he added.
Dr. Perri’s engagement with Blue Shield, G1, 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 G1, 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.
With over 100 surgery centers and 600 surgeons in the statewide network, the Blue Shield California (BSC)-G1 bundle 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 G1’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.