With private payers and employers implementing bundled payments, providers should avoid seeing CMS actions as a reason for scaling down alternative payment model participation. Instead, they should engage with bundled payments across payers to give themselves a competitive edge. Commercial payers will be more motivated to work with innovators, rather than those clinging to the status quo.
The idea is to attract consumers, employers, and payers who are looking to create a narrow network that will provide transparent pricing.
Maximizing the benefits of bundled payments For providers in this environment, the key to success depends on the ability of the organization to foster multidisciplinary teamwork organized around more refined episodic analysis, looking at structure, process indicators and outcomes. These advanced analytics serve as the road map to thrive with this payment model. It is vital that the analytics be clinically focused and risk-adjusted to determine whether variation is manageable or due to the clinical and demographics of the patients.
Four steps First, identify physician leaders to guide the study of current practice patterns, patient throughput and post-acute care. While the physicians facilitate this process, it is recommended that nursing, supply chain, pharmacy and other stakeholders be included.
Second, develop the analytic tools to assess care across the continuum using claims, EMR, process, and patient-reported outcomes. Organizations should look for analytics that allow stakeholders to see severity-adjusted episodes of illness across the entire continuum of patient care. Accurately comparing the total cost and utilization of medical services against peer groups, national norms, and best practices is important as the trend in bundles is to cover post-procedural spend for as long as 90 days. It is essential to compile analytics refined enough to define the current performance and model the expected bundled rates and outcomes. If this step is not performed rigorously, the organization faces considerable risk and discontentment by stakeholders.
Third, determine how the bundled rate will be distributed to the physicians and facilities. This must include incentives for improvement for all stakeholders as margins improve and quality increases.
Fourth, educate the patients and families, and key stakeholders to empower them to work as part of a coordinated team. Providing clear information about the episode can reduce anxiety and improve adherence to recommended therapies and medications pre- and post-surgery. Using navigators is a proven approach to help patients through the episode of care.
