Healthcare reform demands that organizations prepare for the transition from a fee-for-service (FFS) payment model to value-based reimbursement models. Bundled payment models require providers to take on risk for the services provided within defined episodes of care. They also present opportunities to incentivize care coordination, cost reduction, and quality improvement. To effectively implement bundled payments, organizations must have actionable data to find opportunities, set goals, and manage budgets.
The MedInsight® Bundles application offers organizations participating in bundled payment programs the insights they need to efficiently manage the payment models implemented by the Center for Medicare and Medicaid Innovation (CMMI). These models include Bundled Payments for Care Improvement (BPCI), Comprehensive Care for Joint Replacement (CJR), BPCI Advanced, and Enhancing Oncology Model (EOM). With Bundles, organizations can take advantage of the following capabilities to better meet their quality and financial objectives:
Maximized financial performance
Stay informed of shifting reimbursement trends and proactively strive to position your organization to remain at the forefront of financial and revenue-generating initiatives.
Dynamic claims interface
Maintain flexibility to address any unintended impact, especially those bundled payments with broad episode definitions, with self-guided data visualization and analytics.
Increased alignment and adoption
Promote greater transparency and collaboration with reliable data and insights (e.g., such as variation, overall episode costs, and related expenditures) to align incentives.
Deep data and market expertise
Collaborate with a recognized industry leader that has worked with numerous parties to develop episode and payment methodologies and offers complete transparency into the process, including customization.
Accelerated efficiencies and insights
Manage episodes of care with more context and confidence, analyze utilization patterns over time, and drill into the detail of individual patients to drive improvements.
Glide path for future models
Accelerate VBC initiatives and future alternative payment models with a rigorously tested platform that replicates CMS logic and maximizes efficiencies.
Bundles in action
Bundles dashboards
Improve care coordination, quality, and costs
Improve outcomes and costs by managing episodes of care for specific bundled payment programs, analyze utilization trends over time, and gain greater insight into individual patient data.
Optimize efficiencies and outcomes
Scale and streamline operational workstreams with a single, proven platform that enables different stakeholders (i.e., financial, clinical, quality, or administrative) to quickly sift through data according to time frame, provider attendance/operation, beneficiary demographics, or other criteria.
Increase performance, satisfaction, and profitability
Define and measure bundled payments and meet quality and financial targets with increased insights into opportunities to enhance patient care and reduce spend.
Use cases: How VBC Contracts can help
Claims-based reporting
Process claims feeds for all models and obtain detailed views of anchor hospitalizations, post-acute care, patient and provider profiling, target price and quality calculations, and utilization performance.
Cost and value opportunity analyses
Prioritize opportunities to improve financial and clinical outcomes with a clear framework for defining and measuring success and by evaluating utilization shifts to benchmarks and estimated target prices.
Episode volume and characteristics
Monitor episode characteristics (e.g., volume and costs for historical and performance periods, site of services, codes triggering the episode) throughout the entire care process, from pre-admission to the community or home, and in relation to your costs versus targets.
Benchmark comparisons
Identify the types of episodes of care that are most appropriate for a bundled payment arrangement with reliable benchmark data (i.e., baseline, peers, national).
Contract management and intelligence
Support network contract negotiations with enhanced ability to meet the demands, timeframes, and reporting for each bundled payment program and support program implementations.
Payment and settlement
Understand and audit reconciliation reports from CMS to determine whether payments are appropriate given program parameters and calculate downstream incentive payments for contributing providers.
Relevant resources
How digital transformation drives value-based care
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Leading the way in value-based care: Best practices for mitigating risk
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The right data for every model of value-based care contracting
How MedInsight Supports Organizations on the Glide Path to Risk For healthcare provider organizations navigating the array of alternative payment models in use across all phases of value-based care contracting, the complexity can be daunting. From small physician groups operating on a largely fee-for-service basis to health plans managing the claims of tens of thousands … The right data for every model of value-based care contracting
Reducing risk to drive VBC success for ACOs
As value-base care (VBC) progresses, accountable care organizations (ACOs) face a significant challenge in balancing the quality of care and financial outcomes while taking on increasing financial risk. This task becomes even more difficult without a comprehensive understanding of patient populations and overall performance, making it challenging to sustain value-based care effectively. ACOs typically have … Reducing risk to drive VBC success for ACOs
Reporting Framework for Value Based Care
As the cost of healthcare continues to rise, both payers and providers continue the “triple aim” of delivering effective quality care while managing their costs. Value based care (VBC), or value based reimbursements, has emerged as an effective mechanism for achieving this goal. In fact, based on estimates developed by National Business Group on Health, … Reporting Framework for Value Based Care