Understanding a new, mandatory payment model

#5in5_Blog_BannerAs the health care industry moves toward population health management, providers and payers are working to determine which value-based reimbursement models show the most promise.

The Centers for Medicare and Medicaid Services gave the bundled payments a boost this year by making the model mandatory for a number of hospitals — first for hip and knee replacements and recently announcing an expansion to cardiac care.

Under bundled payments, a provider receives a lump-sum payment and delivers all health services for a single episode of care over a specific period of time.

That means the hospital-patient relationship doesn’t end when the patient exists the facility.

Under the Comprehensive Care for Joint Replacement Model, or CJR, hospitals are responsible for the cost of care and any complications for 90 days after discharge.

The goal is to encourage more communication and collaboration across health care facilities in hopes of reducing cost, waste and disparities in quality.

Download the latest #5in5 interview to discover how CJR affects your organization, how bundled payments fit into a larger discussion of value-based care, and keys to bundled payment success.


About the Author:

Jeremiah Reuter, ASA, MAAA
Managing Director, Network & Population Health Consulting

Jeremiah is a Managing Director in the Accountable Care Services team in the Network and Population Health Consulting division in Optum. He has over 14 years of experience in the health care actuarial field. His primary focus has been in the area of U.S. healthcare consulting. He has worked with health insurance plans, health care providers, ACOs, Medicare Advantage plans, CMS and state and national regulatory agencies. Jeremiah also has an extensive background in international healthcare, having spent two years working with the National Health Service (NHS) in the UK as well as projects in Canada.

Jeremiah’s currently serves in the Chief Actuary role for ACOs as well as leading the valuation team for a top-10 health insurer. Jeremiah is also currently consulting with health plans and health care providers on the impact of the Affordable Care Act (ACA) legislation on providers.
He is a member of the American Academy of Actuaries and an Associate of the Society of Actuaries. Jeremiah graduated magna cum laude from Mayville State University with a double major in mathematics and physical science. He also holds a Master of Science degree in mathematics from the University of North Dakota.

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