Managing Risk And New Payment Models

Case Study

Mount Sinai Health System — New York City

Joint Replacement Bundled Payment Program

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Mount Sinai Health System (MSHS) began offering a joint replacement bundled payment program in April 2016 in partnership with 32BJ Health Fund (the health benefits division of a large labor union) and Empire BlueCross BlueShield. The program offers 32BJ members and their dependents total hip- and knee-replacement surgeries at no out-of-pocket cost with a coordinated patient experience from presurgical consultations through recovery.

Mount Sinai had been working to improve efficiency around episodes of care, an effort that was fueled by the organization’s participation in the Medicare bundled payment program. Empire BlueCross BlueShield encouraged Mount Sinai leaders to talk to one of Empire’s plan sponsors, 32BJ Health Fund, which looks for ways to improve outcomes for plan participants.

Patients in the program attend a “joint class” before surgery to learn about the procedure and recovery. Each patient is matched with a care guide who engages the patient at every step of the way — from before admission to surgery preparation through the recovery process. Care guides visit the patient in the hospital, support family members, assist with the transition home, coordinate postsurgical care, arrange for transportation and follow up via phone or email for 30-45 days after surgery. By establishing a single point of contact for the entire process, MSHS provides patients with a more coordinated, lower-stress experience.

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