Bundled Payments: Fueling Drive to Value Based Care

money-3012844_640Value based care comes in many forms, but the consistent goal is to reward the quality of care over the quantity of care. A variety of initiatives have been floated in the past few years with the goal of promoting the transition to value. Bundled payments have been one of the few mostly well received such initiatives. Bundled payments create a single payment around an entire episode of care, which is designed to cover the entire continuum of care around the specific issue.

By creating a single unified payment, bundled payments encourage and push collaboration among all different providers. For example, success can require independent physicians, hospitals, and post-acute providers to come together to assess the best means of caring for a patient. When providers need to work together, then barriers to information sharing, old misconceptions, and other issues can end up being addressed too. Ultimately, bundled payments help to demonstrate that different providers cannot continue to operate as islands.

The form of bundled payments garnering the most headlines are the bundled payment programs run by the Centers for Medicare and Medicaid Services through Medicare. The Bundled Payment for Care Improvement (BPCI) Initiative has been voluntary and can involve any one of 48 different episodes of care. The program is expanding as well with a new BPCI Advanced initiative that will try to build upon prior experiences. With criticism about many of CMS’ efforts at moving to value based care, bundled payments seem to be one avoiding most of the issues.

With CMS moving Medicare in the direction of bundled payments, private insurers are also following suit. More commercial bundled payments are being created with some of the top insurance companies participating. While not necessarily a new idea, Humana recently announced the launch of maternity care bundled payments to create an episode around pregnancy. Blue Cross plans across the country have also hopped on board. Such plans have been around for a while, but it seems as though new bundles are being announced with regularity now.

Further, some bundled payments are even cutting out insurance. Large employers are directly approaching providers for the creation of bundled payments. Emory Healthcare and Walmart recently announced both bundled payments and a localized accountable care organization for a certain metro region.

All efforts with bundled payments will likely share one common element: data are essential. When constructing a bundled payment, trying to operate under one, assessing results, or any other number of activities there must be data to rely upon. Once the data are obtained, then it is necessary to be able to analyze and apply lessons learned or detect trends to address issues that could lead to failure under the bundled payment. There are many moving parts and all sides are still learning to play in this game.

Many of the challenges for bundled payments and the opportunities were addressed in a recent discussion I had with Chris Garcia, the CEO of Remedy Partners on a recent Healthcare de Jure. Listen to that discussion and join the conversation:

Time will tell whether bundled payments will succeed, though early results seem promising. Overall, the mantra should be to keep moving forward, keep improving, and keep finding ways to provide the best possible care to patients.

About Matt Fisher

Matt is the chair of Mirick O'Connell's Health Law Group and a partner in the firm's Business Group. Matt focuses his practice on health law and all areas of corporate transactions. Matt's health law practice includes advising clients with regulatory, fraud, abuse, and compliance issues. With regard to regulatory matters, Matt advises clients to ensure that contracts, agreements and other business arrangements meet both federal and state statutory and regulatory requirements. Matt's regulatory advice focuses on complying with requirements of the Stark Law, Anti-Kickback Statute, fraud and abuse regulations, licensing requirements and HIPAA. Matt also advises clients on compliance policies to develop appropriate monitoring and oversight of operations.
This entry was posted in Accountable Care Organization, ACO, Business, Healthcare, Healthcare Reform, Value Based Care and tagged , , , , , . Bookmark the permalink.

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