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Bundled payments expand beyond traditional episodes


Bundled payments are becoming an increasingly popular form of reimbursement, but payers must evolve their operations and infrastructure if they want bundled payments to reach mainstream implementation, according to a new study from the Health Care Incentives Improvement Institute.

"With the adoption of bundled payment methodologies by major public payers and with the efforts by commercial payers to bring the programs to scale, we anticipate a rapid growth in use of bundled payment methodology over the next few years," the study states.

Not only are insurers using the bundled payment model more frequently, but they're also expanding it into new areas, including chronic and acute conditions like developmental disabilities and respiratory infections. Horizon Blue Cross Blue Shield, for example, has hundreds of bundled payment contracts that cover a range of services from pregnancies and deliveries to joint replacements and breast cancer, according to a blog post in the journal Health Affairs.

What's more, bundled payments are leading to improved quality and lower costs. "All interviewed payers report cost savings, some at significant levels, and most report at least some impact on quality," states the report.

But to make bundled payments an even more mainstream reimbursement model, insurers need to improve their operations and infrastructure. They must simplify the program design while streamlining and automating budget-to-actual cost reconciliations. Insurers also must upgrade their claims adjudication systems to better manage more than simple fee-for-service transactions.

The study also determined insurers need to give providers necessary data on a timely basis so they can quickly identify any problems. And they must develop their benefit designs to help drive members toward providers offering lower bundled prices.

To learn more:
- here's the study (.pdf)
- read the Health Affairs blog post

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We need more bundled payments--fast
Many providers still on fence regarding bundled payments
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