Bundled Payment 101: A Guide to Getting Started Quickly (Part 2)

In part 1 of this series, we covered claims data considerations and how the use of claims analytics is essential for the successful implementation of bundled payment. In this installment, we’ll look at how health plans and providers can leverage technology to collaborate more effectively and streamline the speed-to-market of value-based programs.

Step 3: Collaborate Transparently with Your Provider Network

To successfully achieve the goals of value-based reimbursement strategies, health plans and providers need to work together to have productive discussions around value and cost. Establishing trust for these discussions requires that you use credible third-party validated clinical and financial facts. Providers need confidence in the costs referenced and the care plans recommended.

A claims analytics platform that is certified to the standards of the Health Care Incentives Improvement Institute (HCI3) can produce clinically validated models of the appropriate range of costs and outcomes for myriad episodes of care, ranging from knee replacement to stroke. This third-party validation reduces the complexity of the analytics, and helps establish a foundation to enhance provider trust in, and alignment with, the key metrics on which physicians will be measured.

Access to a comprehensive claims analytics tool will help you have an articulate conversation with provider partners as you explore which services might cause cost and quality issues. Your ability to share detailed information by practice, provider, and member will support transparent, fact-based discussions as you work to identify potentially avoidable costs.

A dynamic platform can help you unlock your analytics to support your efforts throughout the lifecycle of your provider agreements. It can support network contract negotiations, network management, and can initially help you get buy-in for value-based reimbursement programs.

Lastly, benchmarking tools can allow providers to view their performance in relation to peers within geographic and episode volume parameters. As you look at claims retrospectively and, eventually, prospectively, analytics can help you understand where you’re starting to bend the cost curve, so you can identify which strategies are or are not improving care quality.

Effective bundled payment programs require close alignment with your provider network. A tool that promotes transparency and collaboration will support adoption and help you optimize savings.

Manage Your Provider Network with 3 Levels of Analytics

  1. View performance by practice and provider
  2. Understand specific member scenarios and identify any potentially avoidable costs
  3. Review provider benchmarking report for peer-to-peer analysis

Step 4: Operationalize Your Bundled Payment Strategies

Given the complexity of administering bundled payment models, it’s crucial to take advantage of analytics and automation technologies. Technology should be used to help you streamline the speed-to-market of value-based programs, allowing your organization to realize cost savings sooner.

Integration with your established systems is important, but the new reimbursement models require moving beyond the business processes and IT systems that were built to pay for individual health care services in isolation. Using a configurable, cloud-based claims analytics tool that doesn’t require IT resources, and can integrate with your existing workflow and software, is ideal. This will allow you to quickly analyze and refine existing bundled payment programs, and more easily launch new programs.

As your bundled payment claims move to claims processing, the complexity of administering the program is compounded. It might be too cumbersome for in-house teams to manage the adjudication process with existing enterprise systems. A platform that uses a claims auditing rules engine will streamline incorporation of bundling into the adjudication workflow. This will also pave the way for a transition from retrospectively reconciling payment to prospective payment contracts, as your organization moves further along the value-based reimbursement continuum.

To ensure bundled payment programs continue to deliver value, ongoing monitoring and reconciliation of the programs is essential. The analytics engine should help monitor your programs against projections, calculate appropriate levels of reimbursement, and suggest further refinements to the model.

Let’s Get Started!

As health care delivery increasingly moves toward value-based reimbursement programs, the business and care models become increasingly intertwined. Organizations need tools that help identify how quality and care decisions impact costs, and support the implementation of value-based programs. These programs provide the opportunity to change the dialog between health plans and providers. Using a claims analytics tool that promotes visibility and transparency can help foster an environment of collaboration.

An existing solution, the HealthQx® analytics platform from Change Healthcare, delivers on all of the elements essential to supporting your bundled payment strategy as outlined in this quick-start guide. HealthQx can help you unlock access to your claims data, leverage claims analytics, collaborate effectively with your provider network, and operationalize your bundled payment strategy to scale.

HealthQx is an on-demand software service that helps health plans and providers simplify and automate the design, deployment, and monitoring of complex mixed- and alternative payment models such as bundled payment, Accountable Care Organizations, and other at-risk arrangements.

It provides at-a-glance dashboards and easy-to-use data exploration and visualization capabilities to empower data analysts, actuarial teams, and payment innovation leaders to bring healthcare business intelligence to light, enhance provider engagement, and improve transparency during contract negotiations.

Andrei Gonzales, M.D. is AVP, Product Management, Value-Based Payments, Software & Analytics, at Change Healthcare.

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