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ideation session at C1 Innovation Lab

Connecting With Members to Improve Outpatient Procedure Experience

A growing number of people who need hip or knee replacements are getting the surgeries in outpatient centers.

That means they’re back home to recover on the same day they have the surgery instead of spending a day or two in the hospital.

Health care providers are finding that many patients do just as well or better when they have the surgeries in ambulatory surgery centers or hospital outpatient departments — and the costs are lower. But success may depend on careful coordination of education, care and support before and after the procedure.

Case managers from Blue Cross and Blue Shield of Texas (BCBSTX) can fill that role — but only if they’re alerted when members are scheduled to undergo an outpatient procedure. The Dallas-based C1 Innovation lab is testing a way to make sure that connection is made.

The pilot is already proving successful. In one instance, a physical therapist failed to show up after a member’s outpatient knee surgery. Fortunately, Amanda Higdon, a registered nurse and C1 health care innovator with BCBSTX, had already been in touch with the member before and after surgery.

The member called Higdon, who quickly scheduled another in-home therapist in the member’s provider network.  

“It’s important to start physical therapy as soon as possible to help regain as much activity as possible,” says Higdon, a registered nurse. “If you wait too long, you can lose movement. Without this pilot program, I’m not sure how long it would have been before this patient got physical therapy.”

Ideating solutions

The purpose of the C1 Innovation Lab is to reimagine how employers and health plans work together to improve members’ experience with their benefits and care and deliver better health outcomes at lower costs.

Two large employer clients wanted to develop a way to provide a more seamless experience for employees and covered family members undergoing outpatient joint replacement surgeries.

C1’s member experience and innovation team discovered BCBSTX case managers weren’t automatically notified ahead of outpatient procedures as they would be when members scheduled surgeries in the hospital. They were missing the opportunity to provide education and support for those members, says Jillian Sykes, a registered nurse and unit manager of clinical operations with the C1 Innovation Lab.

Under the pilot program, case managers get readouts triggered by prior authorization for outpatient hip, knee or spine surgery.

[Learn more about the C1 Innovation Lab]

With this information, Higdon says, she and her team members contact members to share information about what to expect and make sure they have equipment they need at home and receive any necessary follow-up care and support.

The C1 Innovation Lab team plans take what it learns from the pilot to look for ways to scale the approach to additional clients.

More than 500 members have already been contacted in the first five months of the program, and the team has also successfully collaborated with 60% of the members’ providers who they attempted to contact.

“Members are surprised and really grateful,” Higdon says. “It’s another person advocating for them and making sure they know what’s happening before and after surgery.”

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