Bundled Payment Models: Bottom-Line Strategies for Insurers

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Publication Details

  • Pub Code: GC4M02-11WEB
  • Pages: 136
  • PDF version: 5,915 KB
  • ISBN: 978-1-936230-80-8
  • Copyright 2014

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Bundled Payment Models: Bottom-Line Strategies for Insurers

Case studies of two insurers that have developed bundled payment systems to reimburse providers for several episodes, including total joint replacements, congestive heart failure and colonoscopy. From how the payers got started to the pitfalls they encountered and the latest financial and quality outcomes seen, this report walks through the entire process of building a bundled payment system.

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AIS’s Management Insight Series: Providing practical solutions to complex business challenges with the help of the industry’s most insightful advisors and managers

Insurers across the country are experimenting with bundled payment initiatives that bring providers on board as partners in an effort to control costs while improving quality and member satisfaction. Bundled Payment Models: Bottom-Line Strategies for Insurers provides the details of how two insurers — Horizon Healthcare Services, Inc. and Arkansas Blue Cross and Blue Shield — developed successful programs to reimburse providers for episodes of care, combining payments for all aspects of treatment rather than paying providers individually for tests, office visits and procedures.

Filled with details on how they worked with provider groups to choose the episodes, agree on budgets, track quality measures and share savings — and what results they achieved — the report offers insights from senior executives at the two Blues plans on:

  • How the insurers established cost and quality targets, and shared cost and quality data with providers.
  • The differences between retrospective and prospective bundled payment models and how to transition from the easier-to-implement retrospective method to a prospective program.
  • The financial and quality outcomes the insurers have seen.
  • How the insurers share savings with providers and to what extent providers are taking downside risk, too.
  • Special circumstances to consider, such as how often costs are reconciled and how payers handle catastrophic “outlier” episodes or patients.

Bundled Payment Models: Bottom-Line Strategies for Insurers offers valuable tools for health insurers, providers and others involved in reforming how health care is delivered and financed. Order today! (Your order includes a PDF version available immediately when you order and a print version mailed to you within 5-7 business days.)

Table of Contents

  • Introduction
  • Bundled Payments: The Future of Care
  • Horizon Blue Cross and Blue Shield
  • Arkansas Blue Cross and Blue Shield
  • Q&A Session
  • Appendices
    • Appendix A: AIS Coverage of Bundled Payment Programs
    • Appendix B: Bundled Payments for Care Improvement Initiative Fact Sheet
    • Appendix C: Sec. 3023 — National Pilot Program on Payment Bundling
    • Appendix D: Post Acute Care Episodes
    • Appendix E: Arkansas PCMH Provider Manual 2014
    • Appendix F: Guide to Reading Your PCMH Report
    • Appendix G: Sample Report

Written By

This report was adapted from a March 2014 AIS webinar presented by Lili Brillstein, Director of Episodes of Care at Horizon Healthcare Services, Inc., and Steve Spaulding, Senior Vice President of Enterprise Networks at Arkansas Blue Cross and Blue Shield. It has been updated by AIS’s editorial staff to include appendices filled with relevant background coverage of industry developments, state and federal agencies’ guidance and preparatory materials and other resources.

Written For

  • Health plan CEOs, CFOs, chief operating officers, provider relations executives, government affairs directors, new-business developers, product development directors, market research managers, attorneys and accountants.
  • Provider organization CEOs, chief operating and financial officers, directors of managed care, government affairs and compliance executives, risk managers, attorneys and accountants.
  • Pharmaceutical and pharmacy benefit management executives
  • Attorneys, actuaries and consultants

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Bundled Payment Models: Bottom-Line Strategies for Insurers

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