The business arrangements that last are those in which everyone wins. Customers frequent stores where they find excellent value and service. Businesses work with other businesses when they trust each other and when there is mutual benefit.
Even in the adversarial world of health care contracting, the most successful agreements happen when all parties — payers, providers and patients — feel like the value they receive is on par with the value they give.
How can payers, providers and patients all benefit from bundled payments?
I’ve found that creating programs with the following five elements is the key to success:
- Strong strategy. Upfront analytics and modeling help providers and payers determine which type of bundled program will work best for their organization before they enter into contracts.
- Involved clinicians. Organizations need strong clinicians that will practice with the bundled definition in mind and work with clinical champions to help get other clinicians on board.
- Effective technology. Having solutions to help manage the financial and operational elements of bundles helps reduce errors and increase consistency.
- Flexibility and patience. Developing a perfectly tuned bundled program is an iterative process that takes time, but that process can’t happen on paper. Bundled programs get better with experience.
- Consistent monitoring. Issuing ongoing bundled dashboards and/or scorecards can help clinicians know if they need to course correct and iteratively refine and improve their performance.
Experts can jump-start your bundled programs
An experienced partner can help your organization either get your bundled programs up and running or improve your current program. Look for partners who can help you with the following capabilities:
- Program analytics: Partners adept at data and analytics can help you fine-tune bundled definitions that pinpoint the right episodes at the right price.
- Contract management: A bundled partner can help you store and manage bundled contracts for each trading partner, product, and line of business.
- Financial administration: A partner who can manage the bundled process from claim receipt through payment can keep your organization from taking on another administrative burden.
- Performance and operational reporting: A full-service bundled program will provide reporting that helps you confirm you are on track, help you course correct or help you target program growth areas.
Bundles make patients the ultimate winners
When bundled programs run like a well-oiled machine, patients are the real winners. They receive high-quality care, and they are shielded from administrative snafus, such as denied claims that hamper their overall care experience.
Bundled programs help foster stronger collaboration across providers, payers, and employers, enabling longer-term, value-based clinical and financial benefits for patients and health care organizations, alike.
For a more thorough review of how to succeed in your bundled payments arrangements, download my white paper.
About the author
General Manager, Optum Payment Innovation
David leads the development of financial administration platforms used to execute value-based contracting programs. Prior to joining Optum, David spent 17 years working with an enterprise network administration and claim pricing organization. Serving as both COO and CIO, David gained a great appreciation for finding the right operational and technical balance that align to organizations’ visions. Today, David focuses on enabling organizations to better deploy their payment innovation strategies.