U.S. Healthcare Solutions LLC  
Case Study

"US Healthcare Solutions provided us with access to a national payor and guided us through the complexities of developing and obtaining funding for a Pay for Performance (P4P) program.  Now in its second year, the program is a positive change for the hospital."

Client: Doylestown Hospital
Richard Reif, President and CEO, Doylestown Hospital

Doylestown Hospital made a strategic decision in 2001 to invest in systems designed to improve patient safety and outcomes. Key to the plan was the creation of the Improving Systems Leadership Team (ISLT), chaired by President and CEO Richard Reif and consisting of physicians, nurses, administrators and others who provide healthcare services in the hospital.

More than a dozen initiatives are managed by the ISLT process, resulting in a gradual reduction in Length of Stay (LOS) for the 200-bed community hospital.

The Problem
The reduction in LOS, combined with single-digit hospital margins and potential revenue losses due to per diem reimbursement, placed the hospital and its ISLT program in a Catch-22 situation. Improvements in patient safety and quality had the potential to harm the hospital financially.

After a few years of successful implementation of quality initiatives, the hospital was unsuccessful in beginning a dialogue with a major insurer to amend its contract with a P4P component.

The Solution
US Healthcare Solutions was engaged to explore opportunities for establishing a dialogue and developing a strategically-directed relationship with selected payors.

Over the course of a few months, Aetna, members of Doylestown Hospital’s ISLT and US Healthcare Solutions developed a Pay for Performance program that incorporated the hospital’s quality efforts and was consistent with Aetna’s performance-based contracting philosophy. The end result was a multi-year agreement to reward improvement in quality and patient safety at Doylestown Hospital.

The rapport developed between Aetna and Doylestown Hospital has led to discussions about additional patient safety initiatives and options for alternative reimbursement approaches with incentives for the hospital and its Medical Staff.

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