HCI3 Update from the Field: As Bundled Payment Becomes More Prevalent

Submitted by francois.debrantes@hci3.org on Friday, October 7, 2011 - 09:16

Newtown, CT – October 7, 2011

As episode of care payment (a.k.a. Bundled Payment) becomes more prevalent, private and public sector payers will have to work through member benefit issues – in particular when bundled payments are prospective budgets against which FFS claims accumulate. This and other internal plan operations issues reveal the antiquated nature of the claims and benefit platforms that have inflated US healthcare spend. For every problem, however, there are solutions, and in this new report we reveal a few that will help bridge the current technological gaps. Some are really simple, like complete transparency in payment methods for plan members, so that they understand the co-insurance impact of retrospective reconciliations on overpaid FFS claims. Some are more complex, like calculating the "base" episode price and fixing co-pays to that base. And all make an attempt to help payers implement bundled payments today, while internal operations and technology solutions catch up.

What this means to you – there are always a hundred reasons why we shouldn't implement innovative programs, but even when there's only one good reason against the hundred, it should prevail. Especially when that reason is to provide safer, higher quality and more affordable care to everyone. We've seen the power of good incentives on improving quality and affordability, and we've also all lived far too long under the power of destructive incentives of FFS. With every day that goes by one more US resident goes without coverage, one more patient suffers from an avoidable complication, one more business lays off workers. That's the destructive power of FFS, and there simply aren't enough reasons to keep this going. So we'll keep breaking down the barriers, as we do in this report, for the good of all.


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org