HCA & Dignity Health: Advanced Bundled Payment and Risk Sharing Program Management

Introduction

In a role involving regional network management at naviHealth/Cardinal Health, significant achievements were made in managing 14 hospitals under Dignity Health and HCA Hospitals, along with over 50 Skilled Nursing Facilities (SNFs). This case study highlights the expertise in bundled payment and risk-sharing program administration, leading to substantial shared savings and enhanced financial performance in the acute and post-acute care sectors.

Project Overview

Project Title: Advanced Bundled Payment and Risk-Sharing Program Management

Objective: To administer bundled payment and risk-sharing programs effectively across 14 hospitals and 50+ SNFs, optimizing financial performance and risk management.

Solutions and Implementation

The project involved several key strategies:

1. Bundled Payment Administration: Expertly managed bundled payment programs, which require careful coordination and financial acumen to ensure cost-effective care delivery.

2. Upside/Downside Risk Sharing: Implemented risk-sharing programs, balancing financial risk and reward among care providers to incentivize quality care.

3. Deep Vertical Experience: Gained extensive experience in both acute and post-acute care verticals, crucial for understanding the intricacies of these sectors.

Results

The management strategy led to impressive results:

• Substantial Shared Savings: Generated over $1.1 million in shared savings in just one quarter at a single hospital, demonstrating the effectiveness of the bundled payment and risk management strategies.

• Strategic Advantage: The experience gained provided a strategic advantage, especially in light of upcoming bundled payment programs for opioid treatment starting in 2020. This expertise is critical for contractual negotiations and rate table formulation to manage risks and maximize financial performance in bundled payment scenarios.

Conclusion

This case study reflects the depth of experience and skill in managing complex payment and risk-sharing programs in the healthcare sector. The achievements at Dignity Health and HCA Hospitals showcase not only the ability to generate significant financial savings but also the strategic foresight to prepare for and excel in upcoming healthcare payment reforms. The success of these projects underlines Carenodes' commitment to advancing financial performance in healthcare while maintaining high standards of patient care.

Note: This case study is for informational purposes and reflects the project as of the date of publication.