DATA PLATFORM FOR BUNDLED PAYMENTS ARE YOU READY ?B Y - A JAY K HA NDE LWA L
HEALTHCAREPROBLEMHealthcare cost is out of SOLUTIONcontrol. Cost is high and qualityis poor. Make provider responsible for complete care of patient instead of activity. This will reduce volumeWHY , waste and in turn cost. Reward collaboration across providers ata) 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 Modelb) Fragmented care delivery system. Health systems are not one stop shop .
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
WHAT IS BUNDLE PAYMENT ?A bundled payment (BP) provides a single, predeterminedamount of money for treatment by one or more providersduring an entire episode of care.An episode of care is the treatment of a specific medicalcondition 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.
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
DEFINING BUNDLE Episode of care PriceHistorical claims dataHistorical utilization data Inclusion/ExclusionBundled servicesCosting data Quality Measures Payment schedule
DATA CAPABILITY FORANALYSIS - 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