Bundled Payment Models Take the Limelight in Value-Based Care

Bundled payment models, part of the movement away from fee-for-service and toward value-based payment, are generating positive results with industry leaders going on record to support their progress.

In fact, providers Premier is working with that are participating in bundled payment programs with the Centers for Medicare & Medicaid Services (CMS), such as the Bundled Payments for Care Improvement (BPCI) and the Comprehensive Care for Joint Replacement (CJR) programs, tell us they are encouraged by how bundled payment care redesign efforts are engaging physicians, patients and other providers, as well as leading to lower costs and better outcomes.

Bundled payment programs impact all patients

It’s important to note that though bundled payment arrangements have been largely driven by federal programs, the successes providers are achieving are impacting more than just Medicare patients. In fact, the quality improvement processes required for success in CMS bundles create care delivery and other changes across the episode population that can impact all patients with similar conditions receiving care at participating organizations. This is because providers are following a care plan that doesn’t differentiate between payers.

Providers achieving success in bundled payment programs with CMS can leverage these care delivery improvements by negotiating bundled payment carve outs with commercial payers (e.g. traditional commercial, Medicare Advantage). Since CMS models impact more than just Medicare patients, commercial payers are benefitting from better patient outcomes and lower costs for beneficiaries treated at participating facilities. So, it is important that providers succeeding with CMS bundled payment models seek out and partner with commercial payers to achieve additional financial success.

Smart business choice for continued economic viability

If executed properly, bundled payment models also create opportunities for providers to leverage greater financial incentives. For example, in the near future CMS is expected to announce a new voluntary bundled payment program to extend the success of the BPCI program. Providers looking to succeed in value-based payment need to be on the lookout for this new program because it represents a smart business choice to ensure continued economic viability in today’s value-based healthcare environment. Success in these models enable providers to earn additional revenue from savings payments related to reducing waste and improving care across the episode. The new program is also expected to conform with the definition of an Advanced APM in the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program, which allows qualified clinicians to earn additional financial rewards in exchange for taking on risk related to patient outcomes. This will also make healthcare organizations participating in the new program more attractive to physicians, enabling them to seek out and retain top talent.

Keys to successful models

Bundled payment models are an opportunity for healthcare providers and payers to work together on improving health for patients and better managing costs. Some keys to success in bundled payment include:

• Working closely and collaboratively with payers to align patient care goals, performance measures and conditions under a value-based methodology;
• Ensuring performance and processes are standardized and optimized;
• Developing a narrow and committed network of high-value providers across the continuum, including community partners; and
• Implementing robust population health data and analytics, which include cross continuum clean claims analysis and reporting.

Through successful bundled payment programs, providers can enhance their relationship with other providers in the market, as well as their market presence by delivering quality outcomes; payers reduce costs by paying for less unnecessary services and fewer healthcare complications; and, most importantly, patients receive higher-quality, more coordinated care. When these win-win-win situations are created, everyone’s at the table to work together toward the same goals, helping to bend the healthcare cost curve, improve outcomes and create healthier markets.

For more information about risk-based alternative payment arrangements, such as bundled payment models, and the capabilities needed for success, download our whitepaper.