Over the last few years, the Centers for Medicare & Medicaid Services (CMS) implemented both mandatory and voluntary bundled payment programs. In essence, the goal of these payment models are to incentivize more coordinated and cost-effective care by transitioning away from the traditional fee-for-service model and providing a lump sum for an episode of care. With a lump sum, participating organizations must work collaboratively to achieve the best patient outcomes in the most cost-effective way.

UCSF Health’s Office of Population Health and Accountable Care (OPHAC) saw an opportunity to work closely with their Orthopedic department to achieve savings through the Bundled Payment for Care Improvement (BPCI) program. With the program, UCSF is held accountable for the entire episode of care, which also encompasses the 90 days post-discharge. Already partnering with CipherHealth through various initiatives, UCSF saw the opportunity to expand their use of CipherOutreach in order to monitor and engage patients throughout the 90-day period.

By reaching out to patients throughout their episode of care, UCSF was able to proactively address potential issues or concerns. Should a patient indicate a concern on an automated CipherOutreach call, the centralized team within OPHAC reaches back out to the patient to address the issue. On average, the team was able to follow up with patients within three hours of the alert – a large contributor to the program’s success.

The data collected from the calls helped inform the health system of additional opportunities for operational improvement. Members of the UCSF care team were more informed and able to better coordinate care for patients experiencing issues. By improving patient outcomes through greater care coordination, UCSF achieved nearly $1 Million in total savings from the BPCI program with significant improvements in readmissions, SNF and inpatient rehab utilization, and the average length of stay.

Learn more about this program by reading the full case study.