Uncertainty in the healthcare industry, market changes, and complicated legislation make it difficult for companies and providers to offer stellar health insurance plans. Amidst this uncertainty, medical care providers need to put together offers that will attract these new consumers that are looking for affordable and reliable healthcare.
Bundled care could be a solution to these problems.
Until now, providers were traditionally getting paid on a Fee for Service basis. Bundling transitions this payment model to fee-for-episode. A bundle groups the procedures needed to treat a particular condition into said episode and paying the provider a fixed price, thus allowing the providers to get paid faster and in full.
Even with all the evident benefits, providers are hesitant to take the leap into bundled care until they see the model become more universally accepted.
There is evidence of increased demand of bundles, but four hurdles still stand in the way of a smooth adoption of this payment model.
De-Centralized Patient Data Sources
There’s a long history of mistrust and lack of transparency between providers and payers, which results in a relationship that is not conducive to openly cooperating and sharing patient data. This can lead to not having a single holistic view of a patient from a “data perspective”.
Bundled care is built on the premise of managing and understanding the cost of the series of procedures needed to treat a patient’s condition as a whole. If providers do not have access to all the patient’s records and medical history, it can become difficult to provide a true cost estimate for how to treat a condition.
Until there’s an increase in collaboration between providers and payers, it will be difficult to see the full costs that bundling entails and what the necessary adjustments are needed to execute the program on a large scale.
Fragmented Care Delivery
The medical care system lacks a coordination of efforts from the participants in the healthcare process: hospitals, labs, physicians, post-care providers, and so on. They are not used to working together. Instead, they are focused on their particular area of expertise to meet their quotas. This practice often leads to critical gaps in the delivery of care services, which could end in misguided diagnostics and treatments. Defeating the purpose of efficient healthcare services.
Through careful managing and understanding of the costs of healthcare services bundled payments can drastically improve efficiency and cost, as Access HealthNet was able to achieve for a patient that needed a knee surgery.
“I needed knee surgery and the local hospital of my choice told me to expect to pay $30,000. Access HealthNet helped me schedule my surgery at a top tier facility just miles from my home for less than $3,300. I couldn’t be happier.” GA, Lancaster, PA
On top of that, fragmentation also ineffectively allocates precious resources. These consequences include consultants complaining about the poor quality of information sent by referring clinicians, while primary care physicians often receive no information back from consultants.
To reduce fragmented care, healthcare providers have to be incentivized to organize, coordinate, and collaborate with the specific purpose of managing all factors in an episode of treatment, not treating it as the current system does.
Lack of Standard Procedures
Bundled care is feasible when everything is kept straightforward and clear. Simply put, it depends on which patients and what type of medical services should be included. In-depth research is needed to determine the proper combination of services that would be right for the patient. However, that can only happen when a certain condition happens frequently enough to provide sufficient data.
That is the reason why acute illnesses like joint replacement or coronary surgery are better geared to bundling for now. A chronic condition like diabetes that requires changes in lifestyle and behavior is harder to bundle because it doesn’t have a standard treatment, thus cannot be controlled by physicians.
To be able to support a bundling program, the current healthcare system has to undergo a serious transformation.
As it is now, health insurance programs revolve around how providers offer services while bundle arrangements look at how a patient receives care. That will require a new way of looking at the international classification of diseases (ICD).
With pay-for-episode reimbursement systems, some of the payers’ financial responsibility and risks will be transferred to providers. They will have to switch their business and operating models from revenue focused to margin focused, which could be difficult, considering they are not at all used to coordinated care or flat fees.
Bundling care is an advantageous option not only for consumers, payers, and providers but also for the healthcare system overall, as it is in dire need of redesigning. And with the foreseeable changes on the American political scene, this is as good a time as any to proceed in improving it.