It's no secret that as a business owner, you want to know as much as possible about upcoming health plan costs for your company. If you're self-insured, independently paying for claims each month, you’d surely love to predict the impact on your bottom line.
If you have a younger workforce who are starting families, one big, usually unpredictable claims expense is maternity care. Fear of unknown medical bills can suck the joy out of what should be a happy event. Just like you, your employees are eager to know upfront what their out-of-pocket costs will be so they can plan. But that’s hard when there are many services involved, and likely multiple bills coming in for prenatal care, ultrasounds, hospital stays, anesthesia services and delivery.
That’s why HealthPartners is working to make maternity costs simpler and more predictable.
Marty Michael, Director of Network Management at HealthPartners, is proud of the stress-reducing “bundling” program they’ve developed.
But it’s been no minor feat to get there. “A health plan like HealthPartners can't simply come along and say – we'll lump all of these bills into one bill,” he explains.
The various specialist clinicians involved in maternity-related services, who are often from different organizations, must agree on costs, list of services, and how to coordinate them together.
Only when all that detail is hashed out, can Michael’s HealthPartners contracting team get on with the mechanical part of the bundling part of the process – figuring out how to collate all these services in one bill on the claims side.
How bundling helped a Minnesota health care system
To help make the process clearer, here’s an example of how bundling went from the spark of an idea to a comprehensive solution at Ridgeview, a nonprofit, regional health care system serving the southwest metro region of the Twin Cities.
Ridgeview is one of the lower-cost, higher-quality facilities in the HealthPartners network, according to Michael. As a mid-sized, agile, multi-specialty health care system – with strong provider relationships – they’re perfectly suited for the kind of collaboration needed to bundle maternity services.
According to Michael Phelps, President and CEO, Ridgeview, bundling services wasn’t a new concept for the care system. He says that he and Christopher Steffen, Executive Director of Revenue Cycle and Payer Networks, talked about creating a maternity bundle for quite some time after having had success partnering with Twin Cities Orthopedics to create an orthopedics bundle.
“We thought carefully about what other services it made sense to bundle and maternity services – with prenatal, delivery and post-partum care – was at the top of our list,” Phelps says.
Steffen explains what went on behind the scenes once the idea for bundling was born. "The most important step was getting all our partners in obstetrics and pediatrics, along with our clinical leadership, to sit down and say, we'd love to do this together."
And it worked. Now Ridgeview partners – Lakeview Clinic, OB-GYN West, Western OB-GYN, A Division of Ridgeview Clinics, South Lake Pediatrics, and Wayzata Children's Clinic – all have services included in the bundle. With a bundled payment, patients know up front how much it will cost for nine months of routine pregnancy care and delivery. As long as only routine tests and services are required during pregnancy or childbirth, there will be only one “bundled” bill sent out after delivery.
What goes into making a seamless payment experience
While paying for services should now be simple and seamless, the detailed work that had to go on in the background was anything but.
"Initially, one of our main challenges was the great deal of variability with prenatal care and delivery,” says Steffen. “There are many moving parts because there are two patients, not one."
And there are many complicated billing mechanics that need to be sorted out by the health plan. That's where HealthPartners came to the table. "It's one thing to go from an idea to say, 'Hey, we should bundle all this stuff together and then another to make it happen," he explains.
Part of the challenge involved creating a unique billing identifier that would bill and track all related services.
HealthPartners stood out from other health plans thanks to experience in creating different reimbursement models. Having an in-house claims payment platform was also a strength.
According to Steffen, all of these factors mean HealthPartners can pay claims more efficiently than health plans that outsource payments. It also gives them the flexibility to create new payment structures more easily.
HealthPartners was able to make the risk more manageable than Steffen initially thought possible. “They were open to making changes multiple times and helped add in some things we hadn't considered," he adds.
For instance, Ridgeview was able to expand initial plans for the bundle to include not only prenatal care and delivery, but also postpartum services or neonatal care in certain circumstances, as well as immunizations and certain preventive screenings.
Erica Schuler, RN, Director of Affordable Care Organizations and Value Based Networks at Ridgeview, valued the HealthPartners working style. "They always said throughout the process, ‘let's talk about it, let's figure out how to do it,’ and it's been a tremendous collaborative effort. They have been highly accessible and very responsive, and we experienced speedy turnaround times."
Why employers should consider narrower networks and bundling services
HealthPartners is committed to bundling as a key way to help lower health care costs.
"Bundled payments help keep costs in check, improve member-patient experiences, overall financial performance, and outcomes, and we're hoping other providers are interested," Michael explains.
Another related initiative is to bundle services at a lower-cost site of care, such as in an outpatient setting versus in a hospital.
According to Steffen, bundling is not just an issue providers or health care systems should be thinking about. It should be on employers’ radars, too.
"It's a true differentiator since many employers are opting for narrower provider network plans to help manage costs," he says. "So, the bundle helps you control your healthcare expenses without necessarily having to limit your options."
And when it all comes down to it, now that future parents can know upfront what the bill and the rates will be – “There's no need to sweat about it,” Steffen adds. “Just enjoy your baby. That's really what matters."
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