Claims systems must be able to manage bundled payments, David Nace, vice president, medical director, McKesson Health Solutions, told AHIP Institute attendees during his Thursday presentation.
Claims systems must be able to manage bundled payments, David Nace, vice president, medical director, McKesson Health Solutions, told AHIP Institute attendees during his Thursday presentation.
Like many healthcare issues, bundled payments are difficult to define. Nace outlined eight points that should be considered before adopting a bundled model:
Simplifying matters, Nace said the road to an effective program requires care management, episode initiation, episode resolution and financial and clinical analytics-all incorporating evidence-based medicine.
Nace recommends that organizations move through three phases to successfully create a bundled payment model.
“Look at how claims are triggered,” he said, “and then ensure that the claims system is on top of it. Finally, if the model is a fully bundled payment, who will receive the lump sum for services rendered?”
Be wary. There are always challenges attached, such as physician and hospital engagement, real-time data sharing, building scalability, quality assessment, price transparency and cost-sharing.
Bundled payments often come out in the same breath as accountable care organizations and patient-centered medical homes–both of which Nace said are compatible with the extended reimbursement system.
Bundled payments have been round since the 1980s. It started with diagnosis related groups covering the care incurred by a hospital and the Heart Bypass Center Demonstration in 1987 that assessed the feasibility and cost effectiveness of a negotiated, all-inclusive bundled payment arrangement for coronary artery bypass graft. That has led to the 2010 Senate Finance Committee’s expanded acute care episode model, including post-operative care, he said.
Muthiah “Muthu” Vaduganathan Discusses the Role of SGLT2 Inhibitors in Heart Failure Treatment
March 27th 2024Editors of Managed Healthcare Executive spoke with Muthiah “Muthu” Vaduganathan MD, MPH, consultant cardiologist at Brigham and Women's Hospital and a member of faculty at Harvard Medical School, about the evolving treatment landscape for heart failure, emphasizing the use of SGLT2 inhibitors alongside other foundational therapies.
Read More
In this second part of a two-part podcast episode, Managed Healthcare Executive's Managing Editor Peter Wehrwein spoke with CeCi Connolly and Margaret "Meg" Murray about Medicare Advantage utilization and challenges, highlighting proposed CMS payment cuts and prior authorization issues.
Listen
With aging populations, osteoporosis rates are set to increase, and researchers are looking for the next innovative drug to help prevent or manage the bone disease as there is currently no drug that completely does so effectively, according to a recent study published in Advanced Science.
Read More
In this first part of a two-part podcast episode, Managed Healthcare Executive's Managing Editor Peter Wehrwein kicks off our new podcast series "DC Roundtable," with guests Margaret "Meg" Murray, CEO of the Association of Community Affiliated Plans, and member of MHE's Editorial Advisory Board, and CeCi Connolly, president and CEO of the Alliance of Community Health Plans, for a discussion on healthcare policy issues.
Listen
2024 Emerging Leaders in Healthcare — Submit For a Chance to Be Featured in MHE's August Issue
March 26th 2024MHE Editors are seeking diverse healthcare professionals from different backgrounds and healthcare sectors, with individual interests. Eligible candidates are early or mid-career leaders with less than 10 years of experience. Award winners will enjoy complimentary passes to the PBMI Annual National Meeting in Orlando, Florida, from Sept. 4-6. Additional perks include a feature in our August issue, a subscription to MHE and more!
Read More