This week’s guest post comes from Dean Farley PhD, Vice President at OptumInsight. An advocate for collaboration across all constituencies for better patient care, here he explains how payers and providers can make bundled payments a reality.

The idea of implementing bundled payments can be intimidating for any hospital CFO. But, as a way of paying providers that combines all the services needed to treat a patient, bundled payments are an inevitable step for both payers and providers as the industry heads toward accountable care.

The challenges of implementing bundled payment models are more operational than conceptual – improving the flow of information between provider and payer, collecting and delivering the right information about services delivered to these patients across multiple care providers, and ensuring consistent reimbursement. It’s obvious how the task can seem overwhelming – as most providers are much more comfortable focusing on the appropriate care model for specific clinical conditions like diabetes or hip fractures – but here’s how every provider can prepare to make the shift:

  • Get Organized – Providers need to determine how to assemble claims into bundles, how much a specific bundle actually costs, and which requirements for treating a patient have been met as part of that bundle. They need tools to notify payers that a patient is covered by a bundle and when the package of services begins and ends. Finally, they need to bundle data across multiple providers in a single claim for payers, and tools to properly distribute reimbursement funds.
  • Divide and Conquer – Payers need to learn how to identify bundled claims within the stream of thousands coming in the door on a daily basis. To do this, they need tools to help understand which providers are involved with each bundle and enable communication with them. They also need a mechanism for identifying services with special exemptions and determine payment details (how much to pay for a bundle and to whom).
  • Crunch the Numbers – Finally, to really change the way care is delivered, both parties need to track how the patient has been treated in different provider settings, and what appropriate care looks like. A database with the ability to query the shared data from both sides, close to real-time, will improve coordination and enable more effective patient management.

Providers need to think carefully about the costs associated with the care decisions they make to successfully implement bundle payment programs. By aligning the incentives between payers and providers to deliver high-quality care to patients, bundled payments are a necessary step to success in any accountable care model. Follow the steps above, and the transition should seem more manageable.

–Dean Farley, PhD