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What it takes to win with bundled payments

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As part of the transition to value-based care, bundled payments are a proven option for healthcare providers to reduce the cost of care while decreasing readmission rates and emergency room visits for certain procedures. But, there are no guarantees that healthcare systems will benefit financially from bundling arrangements. To succeed with these types of risk contracts requires winning over physicians, coordinating post-discharge care and keeping close tabs on post-acute care providers.

It’s a daunting task, but bundled payments are typically a more straightforward form of risk. They are based on a particular episode of care with a defined recovery period, rather than an entire patient population.

Health IT solutions can play a major role in managing the processes and data that participants need to successfully fulfill the requirements of bundled payment plans.

Types of bundled payments
The Centers for Medicare & Medicaid Services (CMS) offers two bundled payment programs:

  1. Bundled Payments for Care Improvement Initiative (BPCI) which focuses mainly on hip and knee replacements
  2. Comprehensive Care for Joint Replacement (CJR) for hip and knee surgeries

Private payers offer similar bundled payment arrangements but may also cover a broad range of conditions including cardiac procedures, cancer treatment, pregnancy/delivery/recovery, mental health and substance abuse.

Redesigning care delivery
Bundled payments require organizations to redesign the way care is delivered. First, payers and providers must agree on the definition of the bundle. CMS defines its bundles, but providers can negotiate with private payers.

Then, healthcare providers need a process that identifies patients who fit a bundle’s definition before treatment takes place. The data in electronic health records (EHRs) typically isn’t sufficient for the task. Cognitive computing, a type of artificial intelligence that includes natural language processing, can extract diagnoses from the structured and unstructured data in EHRs to pinpoint appropriate patients.

Ideally, healthcare organizations should have access to near real-time clinical data from their EHR and other systems from across the continuum of care. A holistic view of the patient’s health and treatments enables:

  • Physicians to better choose the right post-acute care plan
  • Care coordinators to monitor and manage ongoing care and evaluate the risk of rehospitalization
  • Healthcare systems to track costs and outcomes

If you’d like to learn more about how bundled care can reduce overall costs for healthcare organizations, read “Taking financial risk: A primer on IT infrastructure, Part 3: Embrace the bundle”


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