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Proactively managing surgery costs through patient
engagement, shared decision-making, and a focus on quality.
“Unmanaged” Surgery Costs
Surgical procedures account for over 30% of a
company’s healthcare costs.
But unlike pharmacy or radiology, surgical
decisions are largely “unmanaged” with minimal
patient awareness of cost, quality, or alternative
treatment options prior to incurring a large
surgical claim.
The Business Issue…
Surgery
31%
Pharma
10%
Behavioral
Health7%
Radiology
6%
Other
46%
Annual U.S. Healthcare Spending ($2.3 trillion)
“Clinical evidence shows that many patients undergo surgery that they would decline if fully informed and shared
decision-making can satisfy physicians’ ethical obligations and reduce unwanted procedures”.
American Society of Law, Medicine & Ethics
“Although patients always have the right to participate in decisions about their medical treatment, using formal
shared decision-making processes can be especially useful in cases where more than one treatment option is
available, and no treatment is considered ‘best’ according to clinical evidence.
Report of the Council on Medical service. CMS report. American Medical Association.
Proactive Surgery Benefit Management
An opportunity exists to achieve better outcomes and lower costs
by proactively engaging plan members in their treatment decisions.
Independent research shows that as much as 30% of major
surgical procedures are unnecessary and could be avoided or
handled in less invasive and less costly ways.
Additional studies show as much as a 20% reduction in costs
when utilizing “shared decision making” leading to less invasive
and less expensive alternatives to major surgery.
And when surgery is required, choosing a provider offering the
highest quality outcomes for that particular procedure results is
additional savings.
The Opportunity
3
BridgeHealth SBMTM gains control over unmanaged surgery costs with three integrated programs:
BridgeHealth Early Indicators™ - identifying major surgical claims early in the process, when there is an opportunity to intervene.
BridgeHealth Engagement™ - providing medical education, resources and support related to treatment options and alternatives.
BridgeHealth SurgeryPath™ – providing access to providers offering the optimal combination of quality and value.
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Early
Identification
Member
Engagement
Quality Network
Access
The Solution
BridgeHealth Surgery Benefit Management
BridgeHealth uses a combination of claims analyses, communications and case management to identify plan members early in the decision process.
BridgeHealth Early IndicatorsTM
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Plan Members are provided resources, education and support that
enable them to make informed health care decisions.
BridgeHealth EngagementTM
Research shows that when given information on alternative treatments with
similar outcomes, patients will generally choose a less invasive approach
prior to surgery. (Dartmouth Atlas Report 2011)
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Plan Members that require surgery are assisted by BridgeHealth
Care Coordinators to identify and access the high quality providers
available within their health plan.
BridgeHealth SurgeryPathTM
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Quality Matters…utilizing highly rated providers results in lower costs,
fewer complications and faster “return to work”.
BridgeHealth Care Coordinators utilize Delta CareChexTM to
identify the providers offering the highest quality outcomes for the
desired procedure.
In addition to identifying the highest rated providers within the
plan members local area, BridgeHealth also offers access to a
Centers of Excellence across the country:
With case pricing that results in additional savings, and
Plan provisions that offer advantages for the plan member.
The Importance of “Quality”
“Patients can improve their chances of survival substantially at high-volume hospitals
who perform the operations frequently.” New England Journal of Medicine
8
BridgeHealth SBMTM delivers savings two ways:
By avoiding unnecessary surgeries…
when the Plan Member, after learning about treatment
options, avoids an unnecessary surgery or chooses a less
invasive, less costly, but equally effective alternative
treatment.
By utilizing the highest quality providers…
when the Plan Member, after learning about the importance
of quality, chooses an alternative provider for their surgery.
Savings from BridgeHealth SBMTM
10
Quantifying the Savings Opportunity
Proactive Surgery Benefit Management
Engage
Educate
Empower
Higher quality outcomes
“People do not realize that their clinician does not always fully understand their preferences and
values. When this happens, the clinician’s treatment recommendations may be different from what
their patients would have chosen had they been give the opportunity to be fully informed”.
Dartmouth Atlas Report 2010
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Gordon Larson
CMO/Executive Vice President
BridgeHealth Medical, Inc.
630-841-7566 Direct
12
Contact us for a free analysis of the savings a
BridgeHealth SBMTM program could offer…
