Reorganizing Business Operations For Bundled Healthcare Payments

By  |  May 5, 2014
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Payers and providers nationwide are considering a number of new reimbursement modes, including bundled payment options. Bundled payments aim to reduce the costs of administering healthcare and to encourage higher-quality care through shared risk. The model offers several benefits: for payers, the potential to cut costs through a simpler payment cycle and protection from paying for medical errors; for providers, the elimination of waste and improvement in profitability through the delivery of high-quality care; and for patients, the best possible care – delivered more efficiently.

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    To adopt to these arrangements, payers will have to modify the infrastructure and network management to handle bundled claims. Providers will have to modify their systems to accommodate new ways to bill, receive payments and manage patients – new ways that assume more risk. Together, payers and providers must agree on conditions and episodes of care to be paid for through bundled payments, as well as measures to evaluate performance.

    Three Steps that payers can take to transition their operations include

    • In agreement with targeted providers, establish payment parameters.
    • Determine payment models.
    • Invest in the infrastructure for bundled payments.

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