More and more, purchasers are attempting new strategies to combat the rising costs and variable quality for joint replacement surgeries, such as hip and knee replacements. As demand for these procedures grows, CPR wanted to assist purchasers pursuing a way to impact the unpredictability of cost and quality of joint replacement procedures. We have found that a bundled payment program, along with complementary benefit design, is one promising strategy for achieving these goals.
How to use this tool:
This comprehensive toolkit includes a How-to-Guide that provides a framework for implementing a hip and knee bundled payment program along with six plug-and-play tools that purchasers can tailor to their specific needs and relationships with plans and providers and to align the incentives of providers and patients.
Included in this tool:
How-To-Guide: Total Joint Replacement Bundled Payment (PDF): This How-To Guide outlines everything a purchaser should consider when designing and implementing a bundled payment program for total joint replacement and provides instructions for how an when to use the tools that follow.
- Health Plan Questionnaire (Excel): For purchasers seeking to implement a total joint replacement bundled payment program in partnership with their health plan or third party administrator, this tool provides key questions to assess capabilities and set expectations.
- Model Request for Proposals for Providers: For purchasers seeking to implement a total joint replacement bundled payment program directly with a provider, this RFP provides key questions to assess provider capabilities.
- Model Health Plan Contract Language for Bundled Payment Agreement: The toolkit includes a model contract that purchasers can use to execute the bundled payment program through their health plan or TPA.
- Model Provider Contract Language for Bundled Payment Agreement: The toolkit includes a model contract that purchasers can use to execute the bundled payment program through a provider.
- Total Joint Replacement Bundle Definitions: This tool details the bundle by phase of care, provider, facility, prescription, patient
- Bundled Payment Program Side-by-Side: The toolkit includes a side-by-side comparison of various hip and knee bundled payment programs for your reference.