Category Archives: by David Mauzey

To succeed with bundled payments, think win-win-win

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 — […]
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How bundle payments fit into your future reimbursement strategy

While it is true that tools are often as good as the user who uses them, in the case of health care, reimbursement tools become critical. In my last blog post, I discussed how bundle payments have evolved to meet the needs of the current reimbursement environment. In this post, I’ll discuss how bundles are […]
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The evolution of bundle payments

In health care reimbursement terms, bundle payments are old. The concept of receiving a lump-sum payment for a single episode of care — rather than multiple payments submitted and paid throughout the episode — has been part of the reimbursement environment for the past three decades. But while the environment is drastically different today—bundle payments […]
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Learn why to participate in the next-gen CMS BPCI Program

The Centers for Medicare and Medicaid Services (CMS) delivered the next generation of the Bundle Payment for Care Improvement (BPCI) program on January 9, 2018. CMS refined the original program definitions focusing on volume episodes and expanded the eligibility to include physician group practices including surgical centers. Medicare data for applicants over the past four […]
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Aligning network adequacy to meet greater expectations

With the passing of the Affordable Care Act (ACA) and the advent of the health insurance marketplace, network adequacy has come under greater scrutiny. Increased emphasis getting the right providers to consumers is leading health plans away from expansive networks to a narrow, more efficient network design that better serves member needs. Not lost in […]
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