This Week's Challenge: With 500 provider organizations participating in the Bundled Payments for Care Improvement initiative, believed to be the largest demonstration project ever run by CMS, both payer and provider interest in the adoption of payment bundling is at an all-time high. We wanted to see the reasons why one organization, TriZetto®, created member benefits specific to payment bundling.
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What We Learned: "With member benefits, the absolute best practice is to create new benefit programs specifically for payment bundling, for it's a lot easier to understand. In a cardiac program that occured before CMS's ACE Demonstration Project, when they polled the members and asked them why they liked it so much, it was because the members were told, 'I'm going to get one amount to pay as a copay and that copay covers everything.' Our message today is; 'You owe 80 percent' '80 percent of what?' 'I donít know, but you owe 80 percent. And then you owe $15 for each office visit.' 'How many office visits will I have?' 'I don't know.' Getting away from that and offering a single price to the member was an enormously significant contributor to the improved patient satisfaction that they had."
Jay Sultan, associate vice president and chief product portfolio architect for TriZetto.
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Excerpted from Moving Forward with Payment Bundling, a 45-minute webinar, during which Jay Sultan provided perspectives on the emerging bundled payment trend, including: an overview of payment bundling rationale, trends, and outcomes; specific administrative and organizational challenges created with bundled payment programs for healthcare payers; and more.
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