## Delivering Value-Based Bundled Eye Care for Underinsured and Self-Insured Patients
As healthcare costs continue to rise, employers and individuals are increasingly seeking ways to maximize the value of their eye care spending. Value-based healthcare (VBHC) models, which focus on achieving the best patient outcomes at the lowest cost, offer a promising solution. Bundled payment arrangements, in particular, can help drive value in eye care by aligning incentives and encouraging providers to deliver high-quality, cost-effective care.
### The Rise of Value-Based Eye Care
Several studies have demonstrated the benefits of implementing VBHC principles in ophthalmology[1][2][3][4][5]. These efforts have included redesigning eye care pathways to focus on achieving outcomes that matter most to patients, changing the financing model to program budgeting, and using advanced costing methodologies like time-driven activity-based costing (TDABC) to accurately measure the true costs of care delivery.
The results have been promising, with these VBHC initiatives leading to improved patient satisfaction, increased outpatient visits and surgeries, and the ability to identify and implement targeted cost-reduction strategies without compromising care quality[1][3]. For example, one study found that treating non-emergent ocular problems outside the emergency department resulted in shortened visit times, boosted patient satisfaction, and reduced overall costs[3].
### Bundled Payments for Eye Care
Bundled payment models, which reimburse providers a single, pre-determined amount to cover all the care related to a specific medical condition or procedure, are a key component of VBHC. In eye care, bundled payments can be particularly effective for the top 5 most common surgeries:
1. **Cataract Surgery**: Cataract removal is the most frequently performed eye surgery, with over 4 million procedures done annually in the United States. Bundled payments for cataract surgery can cover the entire episode of care, including the preoperative exam, the surgery itself, and postoperative care. We offer Bundled care for Cataract Surgery for $5000 for a mono-focal lens and $6500 for a multifocal lens. We have discount adjustments based on the financial status of the patient.
2. **Refractive Surgery (LASIK/PRK)**: Laser vision correction procedures like LASIK and PRK are elective but can significantly improve a patient’s quality of life. Bundled payments can include the consultation, surgery, and follow-up care. We offer PRK laser vision correction for $2300/eye.
3. **Vitrectomy**: This surgery to remove the vitreous humor from the eye is commonly performed to treat conditions like retinal detachment, diabetic retinopathy, and macular holes. A bundled payment could encompass the entire surgical episode. We currently are not offering this procedure. We can make exceptions on a case by case basis or refer to another qualified surgeon.
4. **Corneal Transplant**: For patients with corneal diseases or injuries, a corneal transplant (keratoplasty) can restore vision. A bundled payment could cover the donor tissue procurement, the surgery, and post-operative care. We are currently not doing transplants but can arrange for the procedure. This bundle runs $12000/eye.
5. **Glaucoma Surgery**: Surgical interventions like trabeculectomy or tube shunt placement are sometimes needed to manage glaucoma when medication alone is insufficient. A bundled payment could include the procedure and related care. Antoher option is implantation of medication to reduce or eliminate the need for eye drops. A bundled price for this is $3200/eye.
### Benefits of Bundled Payments for Eye Care
Bundled payments offer several advantages for underinsured and self-insured patients, as well as their employers:
1. **Predictable Costs**: By packaging all the services related to a procedure into a single payment, bundled payments provide greater cost transparency and allow patients and payers to better anticipate their financial obligations.
2. **Aligned Incentives**: Under a bundled payment model, providers are incentivized to deliver high-quality, cost-effective care, as they bear financial responsibility for any complications or inefficiencies. This encourages a team-based, coordinated approach to patient management.
3. **Improved Outcomes**: Studies have shown that bundled payments can lead to better patient outcomes, as providers focus on optimizing the entire care episode rather than maximizing the volume of individual services[1][3][5].
4. **Reduced Administrative Burden**: Bundled payments streamline the billing and reimbursement process, reducing the time and resources required to manage multiple claims for a single episode of care.
5. **Flexibility and Customization**: Bundled payment arrangements can be tailored to the specific needs of underinsured or self-insured populations, allowing employers and patients to design benefit packages that meet their unique requirements.
### Implementing Bundled Payments for Eye Care
Successful implementation of bundled payments for eye care requires close collaboration between providers, payers, and patients. Key steps include:
1. **Define the Care Episode**: Clearly delineate the scope of services to be included in the bundled payment, from the initial consultation through any necessary follow-up care.
2. **Establish Outcome Measures**: Identify the key clinical, functional, and patient-reported outcomes that will be used to assess the quality of care and guide continuous improvement efforts.
3. **Determine Pricing**: Utilize advanced costing methodologies like TDABC to accurately calculate the total cost of care delivery, and then set the bundled payment amount accordingly.
4. **Ensure Patient Engagement**: Involve patients in the design of the bundled payment program and educate them on the benefits of this value-based approach to care.
5. **Foster Provider Collaboration**: Encourage eye care providers to work as a cohesive team, sharing data and best practices to optimize outcomes and efficiency.
6. **Monitor and Adjust**: Continuously track performance, solicit feedback from patients and providers, and make adjustments to the bundled payment model as needed to ensure its ongoing success.
### Conclusion
As the healthcare landscape continues to evolve, value-based care models like bundled payments are becoming increasingly important in eye care. By aligning incentives, improving outcomes, and reducing administrative burdens, bundled payments can help underinsured and self-insured patients and their employers maximize the value of their eye care spending. Through close collaboration between providers, payers, and patients, these innovative payment models can transform the delivery of eye care, ensuring that high-quality, cost-effective services are accessible to all.
Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910640/
[2] https://ok.vision/self-funded-plans-are-they-the-right-plan-for-your-clients/
[3] https://www.reviewofophthalmology.com/article/covered-or-noncovered-the-cataract-menu
[4] https://money.com/best-vision-insurance/
[5] https://www.aao.org/young-ophthalmologists/yo-info/article/to-bundle-unbundle-that-is-question-modifier-59