Design influences bundled payment success


If insurers want to enhance their bundled payment programs, they must create designs that reward participating providers with more cases. Benefit designs should include reference pricing, centers of excellence and coinsurance differentials, according to a blog post in the journal Health Affairs.

"Bundled payment has real potential to improve care coordination and quality and reduce costs," Suzanne Delbanco, executive director of Catalyst for Payment Reform, wrote yesterday in the blog post.

To best compel providers to participate in bundled payment arrangements, insurers should set up the program to reward the doctors with more patients. "When designed to improve value, bundled payment should include clear quality metrics focused on desired clinical outcomes that providers must achieve to maximize their payment," Delbanco said.

However, insurers shouldn't jump into a bundled payment arrangement with just any provider. That's because many providers aren't well-equipped to handle the financial risk and care coordination, especially since identifying and paying for care bundles is primarily a manual process.

Particularly for providers that are decentralized, Delbanco recommended insurers consider beginning with a shared savings payment model and working toward bundled payments.

Since providers have different capabilities, ownership and risk tolerance, insurers must meet doctors where they are organizationally, FierceHealthPayer previously reported. For example, Cigna bundles payments for episodes of care for deliveries, hip replacements and knee replacements using a model designed with payer-provider collaboration in mind.

To learn more:
- read the Health Affairs blog post

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