Bundled Payment Models: Bottom-Line Strategies for Insurers

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.

Bundled Payment Models: Bottom-Line Strategies for InsurersInsurers 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.

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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.

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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. (Your order includes a PDF version available within 24 business hours when you order and a print version mailed to you within 5-7 business days.)

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