Overcome obstacles to bundled payment success

How to build a successful bundled payment program
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By Dina Overland 

FierceHealthPayer: What do you consider to be the biggest hurdles for payers creating bundled payment programs?

Andréa Caballero: Within each of the steps I mentioned, there is a lot of data analysis and operations that have to occur.

On the payer side, this is still largely a manual claims processing operation and that obviously isn't efficient for them. They don't really like to do things on a manual basis because it can create room for error, is expensive and is difficult to be scaled.

In a perfect world, we get to a prospective payment where the payer gives an upfront payment to the provider for the entire bundle and then that provider distributes the amount to every doctor within the bundle.

We're far away from that, but an interim would be a provider bundling their claims before they submit them to the payer. Then at least they're batched, belonging to one procedure and one provider.

But that also isn't occurring right now. Instead, providers are submitting claims like they always do and payers have to then pull out or flag the claims to process on a manual basis for the bundled payment program. So there are operations that make this really challenging from both payers' and providers' points of view.

Editor's Note: This interview has been edited and condensed for clarity.