Case Study: A Leading Approach to Payment Innovation
SCA Health partners with physicians, payers and hospital systems to optimize surgical delivery
We understand the many challenges facing today’s leading physicians. Our differentiated
approach leverages deep expertise and experience to build shared savings models designed to
reduce health care costs and increase quality of care.
Shared Savings Approach
We coordinate shared savings in a variety of ways including:
Value-Based Fee Structure
A Midwest ASC was operating in a market dominated by a high cost health system that
threatened physicians’ ability to remain independent. The existing ASC fee structure was not
supportive of clinically appropriate case migration, which resulted in ASCs remaining
out-of-network or in partnership with high-cost hospital systems.
Transitioned facility to in-network status via a value-based facility fee schedule
Physician Quality Incentive
For an ASC in the Southeast, physician employment and strict CON laws hindered independent
ASC viability. To promote and optimize the use of ASCs for appropriate services, SCA Health worked
with a commercial payer to develop an incentive structure for surgeons.
Aligned the underlying economics for surgeons who improved quality and cost-of-care for
clinically appropriate outpatient surgeries
To accelerate clinically appropriate case migration in the Midwest, SCA Health implemented a
surgical bundle that promotes higher quality care and lower costs, and a streamlined
approach to the surgical and recovery processes.
Create a comprehensive bundle that consolidates physicians’ fees, facility charges and
Promote clinical benefits that include improved quality and patient care; as well as
Physician Quality Incentive (Surgical Hospital)
In the Mountain West region, two high-cost hospital systems significantly impacted the
availability of high quality, lower-cost surgical care. SCA Health worked with a major commercial
payer to develop a quality-based value network of surgeons, who are recognized based on
clinical outcomes and efficiency.
Organized current physician partners and organized additional surgeons to participate in
the payer’s quality-based network
Aligned the underlying economics of surgeons who improve quality and cost-of-care for
clinically appropriate outpatient surgeries at the more efficient surgical hospital
To lower the cost-of-care for surgical procedures, SCA Health worked with a commercial payer to
implement an internal efficiency program that shares savings with the patient and payer
through a fixed reimbursement structure when lower-cost implants are selected for the
commercial payer’s patients.
50 percent of the total shared savings are placed into a shared savings pool
To learn more about our innovative approach to shared savings, contact David Aguayo.