As one year ends and another begins, we sometimes take stock of what’s changed or developed in the last 12 months. The online news site HealthPayerIntelligence.com did just that for the health insurance market by defining the top trends of 2016. Bundled payment models made the list.
Certainly the Centers for Medicare and Medicaid Services seems focused on the tactic, with the launch of the Comprehensive Care for Joint Replacement payment model. Private insurers seem to be willing to use the model more. In December, private insurer UnitedHealthcare announced the expansion of a bundled payment initiative.
If bundled payments are here to stay, how can health care providers prepare to participate in these reimbursement models? Providers can set themselves up to succeed by proactively focusing on the following six areas:
1. RISK STRATEGY
Providers need to be able to assess the risk of bundled payment programs. There is risk and opportunity within each, but depending on your organization’s progress in the journey to value-based care some programs may offer a better fit.
2. MULTIDISCIPLINARY GOVERNANCE
When considering a bundled payment model, it’s critical to involve executives from all areas of an organization — care delivery, IT and data management, financial and risk management, care management and patient engagement.
3. RISK ASSESSMENT/ANALYTICS
Data and analytics can not only help organizations assess overall risk associated with participation in bundled payments, but can also assist in measuring results.
4. PROVIDER ENGAGEMENT
Organizations should identify physicians who are cognizant of quality and efficiency to champion any bundled payment model. Providers also need a process in place to engage with doctors who need improvement.
5. POST-ACUTE STRATEGY
Provider organizations can develop a strategy to ensure patients are matched with the appropriate level of care after discharge. Creating a preferred network of skilled nursing facilities, home health agencies and community-based resources can keep the patient healthier by mitigating readmission risk and minimizing post-discharge complications.
6. DATA-DRIVEN NETWORK ANALYSES
Provider organizations can set up processes to identifying high-performing post-acute care providers. That could include finding providers who specialize in particular service lines, like cardiology, neurology, pulmonary, etc.
Bundled payments are the subject of the latest #5in5 episode. Click here to read five questions answered in five minutes.
-How some providers used bundled payments as a stepping stone for taking on broader risk
-How private payers and providers are reacting to CMS’ push for more bundled payments.
-Where bundled payments can have the greatest impact
To read more about utilizing lessons learned from bundled payment strategies, click here to read a Risk Matters article.
About the Author:
Jeremiah Reuter, ASA, MAAA, is a managing director in the Accountable Care Services team in the Network and Population Health Consulting division in Optum. He has 14 years of experience in the health care actuarial field and currently serves in the chief actuary role for ACOs. Jeremiah graduated magna cum laude from Mayville State University with a double major in mathematics and physical science. He holds a master of science degree in mathematics from the University of North Dakota.