Support bundled payment contracts with accurate data and benchmarks

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:

Maximize Profitability

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

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.

Alignment and Adoption

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.

Market Expertise

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.

Efficiencies and Insights

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.

Interactive Cost Modeling

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

Bundles Dashboard
Bundles Dashboard

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

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 Analysis

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

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

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

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

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.

Learn how MedInsight Bundles can help your company

Schedule a demo

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