South County Hospital, Orthopedics Enter Into New Blue Cross Payment Model

Blue Cross & Blue Shield of Rhode Island (BCBSRI) announced recently its participation in an innovative arrangement with South County Hospital and South County Orthopedics & Physical Therapy that recognizes and rewards quality outcomes and patient experience in knee and hip replacements. Called a “bundled payment model,” it is designed to coordinate all aspects of a patient’s care, including surgery, primary care, radiology, hospital services, pharmacy and physical therapy.  

South County Hospital and South County Orthopedics have agreed with BCBSRI on key quality metrics, clinical best practices and an overall cost for a full suite of services. The initiative will encourage further coordination of care among clinicians.

The bundled payment model is becoming more prominent in the healthcare industry and is viewed as an effective way to improve quality while controlling costs, particularly with joint replacement procedures. By providing incentives for quality outcomes and efficient use of healthcare dollars, this approach is intended to lower the overall cost of care and support more collaboration among providers.  

“We are excited to announce this innovative partnership and payment arrangement, which is a prime example of the broader changes that BCBSRI and our provider partners are working toward each day,” said Peter Andruszkiewicz, president and CEO for BCBSRI. “Providers like South County are creating care models that address fragmentation and benefit from new financial incentives where all providers – physician, hospital, radiology, physical therapy and others – are working with a patient’s primary  care physician to manage the patient experience and cost for a total, end-to-end care experience.”

“South County Hospital and its clinicians see the value of treating our patients in a way that considers their entire care experience,” said Lou Giancola, President. “We are pleased that our quality is being recognized this way by Blue Cross & Blue Shield of Rhode Island, and to be at the forefront of participating in this innovative model of care that is based on patient outcome.”

“Being at the forefront of orthopedic and sports medicine in Rhode Island means thinking differently about how that care is provided,” said Robert Marchand, MD, President of South County Orthopedics. “The bundled payment initiative ensures the coordinated approach we believe patients deserve, from the very first appointment through recovery.”

The new bundled payment and coordinated care model became available on October 1, 2013 for all BCBSRI members who receive knee and hip replacements at South County Hospital.