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Bundled payment programs in healthcare becoming more common despite lack of comprehensive IT solution

CMS' renewed interest in mandatory bundled payments includes the possibility of additional participation for oncology and other providers.

Jeff Lagasse, Associate Editor

Recent rule changes from the Centers for Medicare and Medicaid Services has once again brought bundled payments into the national spotlight.

Addressing uncertainty among payers and providers on the future of bundled payments, the latest report from Chilmark Research analyzes the market trends shaping the space with an eye toward helping healthcare organizations adapt to the new value-based payment programs.

IMPACT

There are some concerns and challenges for the healthcare industry, including questions about how smaller-scale HCOs will adapt to increased collaboration requirements, to what extent actual cost savings can be realized through bundling, and concerns about the efficacy of existing IT solutions for enabling the payment models.

Payer motivation to explore bundled payments as a solution to rising healthcare costs remains high, the research found. CMS' renewed interest in bundled payments over the past several months includes the possibility of additional mandatory participation for oncology and other providers.

That in turn has forced providers to reevaluate their strategies, including the processes and technologies they have in place to reduce risk to their revenue streams.

Since no vendor currently supplies a comprehensive solution for handling the intricate requirements of bundled payment programs, providers are forced to assemble a solution from various components of other tools, the authors said.

A fully comprehensive solution would have to include several components, including opportunity analysis; episode definition; quality and cost reporting; contract management and reconciliation; patient engagement; care navigation workflow; and clinical pathway support.

THE TREND

Hospitals that receive bundled payments for joint replacement either voluntarily or through Medicare's mandatory programs, vary by size and volume, but not in spending or quality.

That signals a need for both programs, according to a study released in July..

What the results mean to hospital finance and operations leaders is that voluntary programs tend to engage larger non-profit hospitals, whereas some hospitals with lower volumes and fewer resources might only participate under a mandatory program.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com