5 ways to ensure success with bundled payment agreements

Medicare has set a goal of shifting 50 percent of Medicare payments to alternative payment forms by 2018. It is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payment.

As bundled payment plans continue to gain prominence among alternative options, the Advisory Board Company shared five strategies for providers to successfully navigate commercial bundled payment agreements within the coming years:

1. Evaluate a health plan's experience in bundling. Health plans are much more lenient with providers during the initial pilot phase of a bundled payment program than after a plan has established payment processes and software.

2. Focus on the physician. To simplify contracting and reduce legal concerns, most hospitals use employed physicians in commercial bundling arrangements.

3. Price competitively. Although higher commercial bundling prices may seem more attractive to providers, in reality they will not advance your market share goals if competitor options are more attractively priced.

4. Hedge against risk. Instead of overusing patient eligibility restrictions to reduce reimbursement risk, the Advisory Board recommends risk-adjusted pricing, stop-loss clauses and bundle breakers to ensure complex cases or clinical anomalies don't harm revenue flow.

5. Hold payers accountable. Providers should request a payment rollout timeline to understand steerage expectations during bundled payment initiatives.

© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.