Northwell Health, formerly North Shore-LIJ Health System, is participating in three new Medicare bundled payments programs that are making its 21 hospitals responsible for patients' outcomes from the time they enter the hospital through 90 days after discharge.
Managing a patient throughout this period, dubbed the “episode of care” in the Comprehensive Care for Joint Replacement Model, the Cardiac Rehabilitation Incentive Payment Model and the Bundled Payments for Care Improvement Initiative, will be a significant undertaking, especially because of the system's size.
This year, Northwell is overseeing episodes of care for about 3,500 Medicare fee-for-service patients, who have either received a hip or knee replacement or cardiothoracic surgery. That number is likely to grow to about 5,000 in 2017 when Northwell begins working with patients recovering from heart attacks, coronary bypasses and hip and femur fractures.
Northwell's strategy for handling each episode is pretty straightforward. It involves intensive social work and developing new technology to monitor and engage patients after discharge.
“Hospitals have traditionally had this very paternalistic view that every solutions sits within the intensive care unit,” said Dr. Zenobia Brown, medical director for advanced illness management at Northwell Health Solutions. The episodic payment models force health systems to acknowledge that people are “much more complex.”