Payment bundling is one of the few policy alternatives available to the healthcare industry in which patients, providers and payors do better, explains Jay Sultan, associate vice president and chief product portfolio architect for TriZetto®. It has the ability to reduce healthcare costs by providing actionable real world working tools to change provider behavior and improve quality and efficiency.
In Blueprint for Bundled Payments: Strategies for Payors and Providers, Sultan provides perspectives on payment bundling, including definitions of key elements, advice for payors and providers, what's ahead in bundled payments for primary care, and examples of the payment model at work in one organization.
In this 30-page report, Sultan, who advised participants in CMS's Acute Care Episode (ACE) demonstration, an earlier pilot of episodic payments, also describes a bundled payment collaboration between two surgical groups that has not only reengineered every aspect of care but also generated significant savings for the groups.
Under the CMS BPCI initiative, organizations will enter into one of four payment arrangements that include financial and performance accountability for episodes of care. The three-year initiative will determine whether the models will lead to higher quality, more coordinated care at a lower cost to Medicare.