Managed Care

 

Bundled Payment Programs Multiply

MANAGED CARE July 2014. © MediMedia USA
News & Commentary

Bundled Payment Programs Multiply

Hundreds of hospitals and thousands of physicians are participating in bundled payment programs, and most bundled payment contracts have upside and downside risk, according to François de Brantes, executive director of the Health Care Incentives Improvement Institute (HCI3). “We’re now in the scaling phase of this payment model and no longer in pilot or early stage,” he added.

In a report that HCI3 commissioned, the consultant Bailit Health Purchasing showed that both public and private payers are starting to use bundles as a core strategy to reform both payment and the delivery of care.

Bailit interviewed executives from six insurers and one Medicaid program and found three strong trends. First, the insurers were significantly expanding their bundled payment programs by including more providers and more conditions and episodes.

Second, they were automating resource-intensive processes that had been done manually, usually with spreadsheets.

To automate cost and reconciliation calculations, insurers are investing significantly in information systems from MedAssets, Optum, and TriZetto.

Through these investments, insurers may be demonstrating that bundling is effective at controlling costs, limiting complications, and improving quality.

Third, the insurers were simplifying their methods to make them easier to administer.

The 16-page report is based on interviews with executives from Aetna, Arkansas Medicaid, Arkansas Blue Cross and Blue Shield, Blue Cross and Blue Shield of North Carolina, Geisinger Health Plans, HealthNow New York, and Horizon Blue Cross Blue Shield of New Jersey.

The most common bundled procedures were hip and knee replacements. Less common were bundles for attention deficit hyperactivity disorder, coronary artery bypass graft surgery, colonoscopy, congestive heart failure, developmental disabilities, perinatal care, tonsillectomy, and upper respiratory infection.

One payer reported doing bundles for bariatric surgery and cataract removal, and another is doing adjuvant breast cancer and pregnancy.

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014