Patients & Visitors
How We're Lowering Health Care Costs
Frequently Asked Questions
Why is CHI Health talking about health care costs?
Because it’s the right thing to do. Our mission at CHI Health is to create healthier communities, and cost impacts every aspect of how we carry out that mission. That’s why we’re committed reinventing health care with three goals in mind:
- Better care
- Improved quality
- Lower health care costs.
Because our care is your care, we’re also committed to being transparent about our progress as we strive to achieve these goals.
How is CHI Health tracking its health care costs?
In 2014, CHI Health publicly shared data from a report called the 2013 Centers for Medicare and Medicaid Services (CMS) claims experience. It takes the most common episodes of care – or reasons for hospitalization – and shows how regional hospitals compare in terms of cost.
At that time, CHI Health was performing well and we felt we could build on this success. While we were under no obligation to share this information, CHI Health felt strongly that we should be transparent and accountable for our performance and results.
Is CHI Health making progress?
Yes. The 2015 CMS claims experience report showed that CHI health was at or below the average cost for seven of the 10 top episodes of care. That means for seven out of the 10 most common health conditions requiring a hospital stay, CHI Health cost less while delivering great care – compared to other hospitals in the region. See the output rankings of these results.
What’s making this progress possible?
A lot goes on behind the scenes in health care and we’re constantly looking at ways to be more cost effective while delivering excellent care. Specific dollar figures that can be tied to the 2015 CMS claims experience analysis include:
- Skilled nursing after discharge
- CHI Health acute hospitals - $4,641 per case
- Other Nebraska acute hospitals - $5,052 per case
- Total difference - $411 or 8% less per case
- This means CHI Health’s patients required less skill nursing after discharge.
- Hospital readmission
- CHI Health hospitals - $324 per case
- Other Nebraska hospitals - $506 per case
- Total difference - $182 per case
- This means fewer CHI Health patients required readmission within the 30-day episode.
- Bundle payment model
- CHI Health patients discharged to home pre-bundle - 30-40%
- CHI Health patients discharged to home post-bundle - 70-80%
- Total difference - 40%
- This means that with the bundle payment model, 40% more CHI Health patients were discharged directly to home, rather than to a skilled nursing facility, after joint replacement hospitalization.
The Bundle Payment Model is just one way CHI Health is addressing health care costs. Other initiatives and programs include the Accountable Care Organization (ACO) and Clinically Integrated Network (CIN). FAQs for each follow.
What is a Bundle Payment Model?
In 2014, CHI Health St. Elizabeth was one of the first hospitals in the U.S. to voluntarily participate in a bundle program called the CMS Bundled Payment for Care Initiative (BPCI) for total knee and hip replacement. Not only were costs savings achieved, quality improvements were made in many areas, including reduction in readmissions of more than 10% over two years.
When a hospital adopts a bundle payment model, it agrees to be reimbursed based on this model rather than billing for individual cases. Each “bundle” creates savings by identifying evidence-based practices which are proven to improve patient outcomes and lower costs.
CHI Health has been nationally recognized for our bundle payment programs. Other examples of how this approach reduces costs while improving care include:
- Heart failure patients: Hospital readmission rate was reduced from 20-25% to 7%.
- Sepsis patients: Percentage of patients discharged to a skilled nursing facility rather than home was reduced from 42% to 25%.
What is an Accountable Care Organization?
One way we reduce costs while improving care is through an ACO, or Accountable Care Organization. This provider-led team of hospitals and care providers agree to work together and take responsibility for improving quality of care while slowing the growth of health care costs. Specific ways an ACO can impact patient care by improving coordination among providers:
- Fewer tests and medical forms to fill out
- Personalized care plans for high-risk patients
- Detailed explanations of discharge instructions and medications
- Smoother transition between providers and facilities
In 2015, CHI Health announced Nebraska’s first commercial, product-based ACO. Called Aetna Whole Health, it offered Omaha employers a health care model designed to improve quality, outcomes, efficiency and the patient experience. While health care savings are specific to each employer, the potential savings were estimated to be up to 15 percent over comparable Aetna full network products.
What is a Clinically Integrated Network (CIN)?
UniNet is CHI Health’s Clinically Integrated Network. This physician-driven network brings together providers from Nebraska and southwest Iowa to create a healthier communities by offering more coordinated and effective care.
This network includes physicians, specialists, advanced practice clinicians, metro and rural hospitals, post-acute care facilities and ambulatory surgery centers. Their collaboration through a CIN helps patients in the following ways.
- Care coordination. More than 180 care managers/coordinators and population health coaches (nurses and social workers) work in UniNet-affiliated care settings. They help chronically ill patients manage complicated health issues like diabetes and high blood pressure.
- Pharmacy assistance. UniNet chapters in Kearney and Omaha offer prescription assistance programs.
- In Kearney, the Medication Access Program (MAP) helps fill 4,000-5,000 prescriptions for more than 1,500 patients in a typical year. The average savings for Kearney patients is $2.39 million per year.
- Omaha’s Medical Therapy Management (MTM) program identifies, prevents and resolves medication-related problems and offers counseling on medication affordability, medication management and potential drug interactions/side effects.
- Nutrition. Registered dietitian nutritionists provide in-person and phone consultations to guide patients with diabetes, weight issues, high cholesterol, kidney disease and enteral (tube) nutrition.
- Social work. Social workers identify barriers that interfere with a patient’s care, such as financial, legal, housing, mental health and family issues.
How is CHI Health making health care more affordable for a typical office visit?
One way to reduce health care costs is to offer the right care in the right place at the right time. That’s why CHI Health created different levels of care. These are designed to save you money, time and hassle while providing the excellent care you expect.
- Virtual Care: For just $10 per visit, you can be evaluated and treated by a board certified clinical provider 24/7 via phone or video chat. This approach is ideal for many minor medical conditions.
- Quick Care: Walk in days, nights and weekends at one of our Hy-Vee locations for evaluation and treatment by a board certified clinical provider. A case of bronchitis, for example, costs the patient/insurer $89 to treat here.
- Priority Care: Walk-ins are also welcome at select CHI Health Clinics. These locations offer same-day, unscheduled access to primary care providers at primary care rates.
- Read Omaha World-Herald articles: Health care costs going down? Believe it and Bennington Woman 'her old self again' after knee replacement surgery