In the new era of healthcare reform, providers and payers must manage a delicate balance between financial responsibility and increasing positive patient outcomes. The shift towards a value-based care model is a reflection of this movement. Standing somewhat in opposition to value-based care is the fee-for-service reimbursement model, which is often criticized for allowing for overtreatment and misuse of resources.
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.
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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.
Until recently, employers had to navigate through numerous insurance plans to find one that would cover their employees and work within the company budget. A critical issue with this method is that each procedure or visit was billed separately, resulting in a catastrophic bill. The fear is that employees would not deem the coverage valuable because they are still required to pay out of pocket, even after the employer paid the initial cost of the procedures.
In recent years bundled payments have been gaining traction as an efficient solution for reducing healthcare costs. The United States spends a considerable amount of its GDP on healthcare, and yet our healthcare is nowhere near the best in the world.
There’s a lot of confusion around bundled payment models.
For health services providers, bundled payment programs are a unique way to attempt to develop a more efficient system of providing services for each episode. Essentially, providers agree to take on more patients and are betting on their capabilities to treat their patients effectively to earn additional income.