Private Payors Giving Bundles Traction

Victor JohansonBlog

Often times it is hard to gain any traction in healthcare. New ideas are often stuck skating on ice for a number of years before an actual adoption process begins. The bundled payments mandated by CMS have again been delayed until January 2018, originally scheduled to begin this July, so it may seem as though bundles haven’t yet gotten their skates, however, private payors may be changing that.

Carolyn Magill, CEO of Remedy Partners states, “Three or four years ago, it was more about curiosity. Now the traction is happening.” Private payors are becoming increasingly more involved with bundled payments, as they provide structure and consistency that the current payment system is lacking.

Although it is still too early to make uncontested statements that bundled payments work, there has been positive data published surrounding them, suggesting that if anything, it’s a step in the right direction. Providers also seem to like bundled payments as opposed to other alternative payment programs, because they don’t have to take on as much risk and can somewhat ease into a value-based payment program rather than plunging in head first.

In preparations for the inevitable, Lawrence General Hospital took the leap to bundled payments on their own, rather than waiting on regulations.  The hospital worked to better understand their data and pain points to better prepare for participation in bundles. One of the more difficult parts of managing patients under bundled payments, they came to find, is understanding your outliers and managing their risk, for the costs associated with outliers certainly add up in bundles.

Barnes-Jewish hospital has also recognized the cost impacts from high-risk patients will be significantly higher under bundled payments. To better understand their population and tackle this problem, they implemented risk modeling in the Cath lab through ePRISM to better manage risk.

Risk mitigation strategies will be vital in succeeding in bundled payment environments. To learn more about Barnes-Jewish hospital’s success click here.