Start the conversation about effective bundled payment strategies

How payers, providers make bundled payments work [Special Report]

By Brian Eastwood

At the University of Pittsburgh Medical Center, both community-based and academic physicians help build the "clinical pathway" that accompanies a bundle, says Thomas Aubel, director of medical payment strategy and policy.

This helps the payer side of the organization understand, for example, the standard number of office visits that precede a given surgery and physical therapy appointments that follow it. This input also gives providers an opportunity to modify care delivery based on the work that goes into developing a clinical pathway, Aubel says.

Doctors "never really thought about what they were using and what it was costing, because it didn't really matter to them," he says.

Elaine Daniels, senior strategic contract consultant with Blue Cross and Blue Shield of North Carolina, notes that these clinical pathways extend beyond the walls of the hospital. Care coordinators for procedures included in a bundled payment can play a critical role, she says. They can teach surgery candidates strength training exercises that will speed up recovery, for example, or identify hazards within the home that may cause a fall and prompt a preventable trip to the emergency room.

That represents a whole new level of preventive care, but it's fundamental to the success of bundled payments, Daniels says. "It's a work in progress, and you have to be willing to modify as you see how episodes are working. There has to be a high level of collaboration between all the care team providers, the payer and the member."