The concept of bundled payments has been around for a while now, yet the instances where providers have fully embraced it are rare. The complexity of the process, the skepticism regarding the benefits providers provide, and the necessary background to develop an efficient system has kept this reimbursement method in an incipient stage.
When companies and providers work together to develop bundled payment model contracts, they often discover they pay attention to numerous elements. By definition, a bundle will include three components:
- The criteria for service inclusion which defines what specific services will be necessary for the patient’s treatment.
- A time-frame for each bundle episode agreed upon between the provider and the patient to establish when the bundle begins and when it ends.
- The criteria for including or excluding a patient.
Here are some of the key elements you need to keep in mind when designing bundled payment contracts.
Employer-sponsored health insurance is paid for by businesses on behalf of their employees as part of an employee benefits package. Most employers offer health insurance to employees but don’t know they can establish a relationship with either the hospital or a third party to bypass insurers for a reduced cost of care.
A direct contract lets employers go to a provider directly to engage in a contract for a better price. Employers are able to bundle their healthcare services to drastically reduce the cost incurred per episode of care. The idea is to create one flat rate instead of individually paying a doctor, cardiologist, or surgeon. This also benefits the providers because they receive payment much faster.
Companies like Access HealthNet offer technologies that enable easy bundling and work directly with employers and providers to establish an agreement between the two parties. This agreement will allow providers to name their price and receive this payment-in-full. Employers are also encouraged to “shop around” in their marketplace for bundles and compare episodic case rates.
Access HealthNet connects providers and payers in the most direct way possible, eliminating non-value add middlemen.
Keep in mind that there will always be the risk of financial loss due to extra costs that can appear if additional services are needed. To avoid these possible financial risks when dealing with care providers, payers should clearly define their contracts regarding what the treatment entails and how long is the contract valid for.
Here are the key elements of bundled payments:
The Key Elements of Bundled Payments
A bundled payment system that provides value must take four key elements into account:
- The type of coverage patients have
- Understanding the risk associated with individual patients
- Guarantee of payment for care patients receive
- Clear understanding of how any unforeseen conditions will be dealt with
What bundled payments do is essentially group together a list of procedures a patient receives for a particular treatment of a medical condition. This list can include anything from the initial consultation and the diagnostics the doctors make in the early stages of the care plan, the drugs they prescribe and any service that directly relates to the treatment. Additionally, providers are expected to cover any further costs that arise from complications or emergency situations.
Bundled payments still have a long way to go before becoming the standard in healthcare. Right now, providers still have their concerns, but bundles are slowly gaining traction as a different, more efficient payment model. These key elements should make the process of creating bundled payment model contracts smoother.