In the advent of managed care, getting a surgery can often mean getting bills from many places. A single joint replacement can result in a bill from the hospital, the lab, the imaging company, the radiology group, the anesthesia group, the surgeon and potentially more. This can result in high costs for a procedure. While insurance may often pay these bills, for insured patients, the cost of a plan will go up as a result. Traditional insurance carriers have been loathe to change this, however, as they have a vested interest in keeping prices high, since they make more money when the premium is higher. For self-insured employers however, saving money on surgeries can translate to substantial savings on the price of the premium.
In comes Dutch Rojas, founder of Sano Surgery.
As a broker of bundled payments, Dutch Rojas brings together employers, brokers and surgical centers to negotiate a bundled price for a surgery. This can often yield considerable price savings. To give a simple example, a knee replacement when paid for by insurance can cost over $60,000. When paid for by a self-insured company, this can put considerable burden on the plan, especially with multiple employees per year that need a knee replacement. When paid for by a bundled agreement, many surgical centers will accept less than $25,000. As a result, the plan saves money.
In the interview Mr Dutch explains how bundled payment works, why surgical centers are willing to accept bundled payments, why health insurance plans are reluctant to negotiate bundled agreements and how to go about negotiating a bundled agreement.
[3:03] So can you tell me about bundled payment? How does it work and how does it save money?
[4:20] Can you give some examples of how bundled payment has saved patient’s money?
[05:23] Why have hospital systems and traditional insurance companies veered away from bundled payment?
[07:17] Are there any surgeries that can’t be paid for with bundled payment?
[08:41] How can a plan go about getting a bundled payment contract?
[11:43] Why do both healthcare plans and surgeons/anesthesiologists/surgical centers prefer bundled payment?
[13:45] How can a bundled payment affect premium price?
[15:40] How does DPC fit into a plan with bundled payments?
Mr Dutch Rojas is the founder and CEO of Sano Surgery. He has over 2 decades of experience in the ambulatory surgery market as a broker. Prior to that Mr Dutch was a US Marine.