How to build a successful bundled payment program

Fierce exclusive: Model holds great promise, says Catalyst for Payment Reform's Andréa Caballero

By Dina Overland 

As the health insurance industry continues its shift toward a value-based reimbursement system, more payers are experiencing with bundled payments. Though still relatively experiential--of the 11 percent of all value-based reimbursements, just 1.6 percent are bundled payments--the model "has probably the most promise," Andréa Caballero, program director for Catalyst for Payment Reform, told FierceHealthPayer in an exclusive interview.

Among the most popular procedures for bundled payments are hip and knee procedures, primarily because they're two of the most commonly performed operations in the country. There were 750,000 replacements in 2005--it's estimated that there will be 4 million replacements in 2030. And Medicare pays on average $15,000 for these hip and knee procedures, while private payers spend about $22,000 per replacement.

"That shows that not only is this already a common procedure that's performed, it's going to be performed more often and it's expensive for the payers," Caballero said.

FierceHealthPayer spoke with Caballero to learn more about how payers can help employers implement bundled payments.