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What payers, providers can do to boost use of bundled payments


Though the concept of bundled payments holds great potential to drive reform in the healthcare industry, many critics argue that bundling is challenging from an administrative standpoint and say the model may not save much money if it ends up simply being a variation on fee-for-service payment models, according to Managed Care magazine.

Because bundled payments make up less than 2 percent of all value-based contracts, by one nonprofit's estimate, the Centers for Medicare & Medicaid Services has tried to kick-start the movement through a bundled payment pilot project. Through the program, CMS pays a lump sum for an episode of care rather than paying providers for each individual service during an illness or course of treatment. Recently, CMS announced that 360 more providers will join the program, which it says saved $1 million in its first year.

So to accelerate this payment model's transition into the mainstream, payers and providers must collaborate to determine how to define certain episodes of care, according to Elaine Daniels, who worked with bundles at Blue Cross Blue Shield of North Carolina before joining the informatics company Aver.

"These programs are changing the spirit of the relationship between providers and payers," Lili Brillstein, director of the episodes of care program for Horizon Blue Cross Blue Shield of New Jersey, told the publication. "It's very collaborative."

Providers must also be willing to take on risk, the article notes, as well as hire care coordinators and collect and share data during an episode of care.

Insurers, on the other hand, must harness their analytics systems to manage their bundles by tracking savings and quality measures. Outdated information systems can hold payers back from this opportunity, according to Francois de Brantes, of the nonprofit Health Care Incentives Improvement Institute, which can even encourage providers to contract directly with employers.

Finally, the article states, insurers and employers must design benefits that actually entice customers to use bundled care packages.

To learn more:
- here's the article

Related Articles:
How payers, providers make bundled payments work [Special Report]
Bundled payments can be gateway to payment reform
CMS: Success of bundled-payment program leads to 360 new participants
Payers positioned to lead alternative payment model transformation