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.

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

8. TECHNICAL
CAPABILITIES
To be continued..