Data Platform for Bundled payment
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This document discusses bundled payments as a solution to rising healthcare costs and poor quality. It explains that bundled payments make providers responsible for the complete care of a patient for a specific condition or episode of care, rather than paying for each individual service. This approach aims to reduce unnecessary services, waste, and overall costs while rewarding collaboration across different providers. The document then outlines key considerations for defining and managing bundled payment programs, including setting prices, determining included and excluded services, risk adjustment, quality measures, and data and technical capabilities needed for analysis and administration of bundled payment models.
Data Platform for Bundled payment
- 1. DATA PLATFORM FOR BUNDLED PAYMENTS ARE YOU READY ? B Y - A JAY K HA NDE LWA L
- 2. HEALTHCARE PROBLEM Healthcare cost is out of SOLUTION control. Cost is high and quality is poor. Make provider responsible for complete care of patient instead of activity. This will reduce volume WHY , waste and in turn cost. Reward collaboration across providers at a) Fee for service rewards different platforms of care delivery volume of services provided rather than quality of various ideas to solve the problem care, which can create provider incentives that are - Accountable Care Organization misaligned with those of - Patient-Centered Medical Home both payers and patients. - Bundled Payment Model b) Fragmented care delivery system. Health systems are not one stop shop .
- 3. BOTTOM LINE control cost Use services when need it, share information and use best practices integrate the care delivery system Make it like a virtual one stop shop restructure delivery of primary care Focus on wellness instead of sickness
- 4. WHAT IS BUNDLE PAYMENT ? A bundled payment (BP) provides a single, predetermined amount of money for treatment by one or more providers during an entire episode of care. An episode of care is the treatment of a specific medical condition during a set period of time. The Initiative will pay for services delivered across an episode of care—such as a fractured hip—rather than paying for each service associated with the medical issue separately.
- 5. DEFINING BUNDLE MANAGING BUNDLE • Price • Billing and payments • Services to be included • Utilization • Services to be excluded • Quality • Risk adjustment • Financial performance • Timeframe • Entry and Exit criteria
- 6. DEFINING BUNDLE Episode of care Price Historical claims data Historical utilization data Inclusion/Exclusion Bundled services Costing data Quality Measures Payment schedule
- 7. DATA CAPABILITY FOR ANALYSIS - Financial Data Ability to load claims data Ability to detect episode of care across services Ability aggregate cost Ability to detect exclusions - Utilization Data - How many visits - Time spent/frequency - Risk Factor calculations - Comorbidities - Hospital acquired conditions - Other comlications