“Data transparency will help drive success in the new world of value-based and bundled payments.” That’s the message MedBen President and COO Kurt Harden shared with hospital, health system, and provider group representatives at the 2nd Annual Bundled Payment Implementation Forum on January 25.<\/p>\n
\u201cThe old world of health payments has been about delayed, withheld, filtered, and segmented information,\u201d Harden told conference attendees. “The new world will need more on-demand, widely dispersed, useful, and comprehensive data use.”<\/p>\n
Bundled Payments<\/strong><\/p>\n Harden was among the featured speakers at the conference, which offered professional perspectives on bundled payments, an increasingly common form of provider compensation.<\/p>\n As the Centers for Medicare and Medicaid Services (CMS) move away from a fee-for-service reimbursement model, a variety of alternative reimbursement models are being implemented. CMS Director, Sylvia Burwell says that 90% of the CMS payments will be in the form of alternate payments by 2018 \u2013 among them, bundled payments.<\/p>\n In a bundled payments model, hospitals, health systems, and providers are incentivized to meet payment targets for entire episodes of care. For example, the payment for a hip or knee replacement would cover all elements of the procedure, including the hospital stay, replacement joint, physician charges, anesthesia, most medications, and care for up to 90 days following discharge from the hospital.<\/p>\n Early indications from a variety of nationwide tests on this approach have shown success in controlling costs and improving outcomes for patients. As a result of those successes, CMS announced a mandatory lower joint replacement bundle to be implemented in 67 markets across the U.S. This mandatory bundle, known as the Comprehensive Care for Joint Replacement model, or CJR, will affect over 800 hospitals nationwide who perform lower joint replacements on Medicare recipients.<\/p>\n \u201cStart with the end in mind\u201d<\/p>\n \u201cWhen outlining your data needs for bundled payments, it is best to start where health systems have seen the most success controlling costs,\u201d Harden explained to conference participants. \u201cBundled payments bring a rich new source of longitudinal data on medical care and associated costs.”<\/p>\n Providers will want to focus on information that will help them succeed in this new payment world, Harden observed. \u201cLook at data on length of stay variations, post-acute care settings, readmissions, and supply costs. Organizations that have been successful with bundled have used this information to improve clinical pathways to lower costs and improve care,\u201d he said.<\/p>\n Harden sees this work as benefitting all MedBen clients. \u201cThese alternative payments methods will continue to grow in all areas of health care financing,\u201d he emphasized. \u201cOur analytics team is using the knowledge we gain from this new line of business to help innovate new savings approaches for all of our clients.\u201d<\/p>\n