4 steps to bundled payment success
By Dina Overland
FierceHealthPayer: What steps can payers take to set up successful bundled payments?
Andréa Caballero: The first step is assessing opportunity. Payers and employers have to determine whether there can be cost savings or quality improvement [with bundled payments]. They have to do a historic claims analysis of probably two years. A payer would have to help an employer understand their data and identify average cost among others.
The second step is building the strategy--which includes determining the bundle, the price and the benefit design--to roll out the bundled payment program. That means you really have to start with what is the bundle you're going to use. A payer and employer determine what constitutes a bundle. For example, there could be a pre-surgery evaluation, including surgical episode and all included within that episode, and then care for 90 days after the surgery. But whatever bundle you decide, this step is to determine what it looks like and a target price for that bundle. You do that based on your claims analysis and the market you want to pilot this in.
You also have to develop a benefit design strategy, which is a key part because implementing bundled payment is very complicated. If you don't have a benefit design that encourages people to go to these facilities that have made the investment in building out a bundled payment program, then there's less incentive for them to want to engage in the program in the first place. So you have to somehow create incentives for employees and patients to want to go to these facilities and providers in these arrangements. For example, you could use a center of excellence, reference pricing or a very distinct benefit design differential.
The final step is to monitor the progress. There are steps where the payer has to determine how it picks a provider, including provider characteristics and quality metrics they must be accountable for.
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4 steps to bundled payment success
