Bundled Payments

A Look Inside the Four Most Common Value-Based Care Arrangements

January 25, 2024 - A simple explanation of value-based care is rewarding quality over quantity. However, value-based care arrangements differ in how they determine payments and the level of risk that is assumed. As healthcare organizations warm up to the idea of value-based care, CMS and commercial payers must choose which kind of arrangements they will offer to their provider partners. Value-based care...


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How One Payer Expanded the Boundaries of Maternal Healthcare Benefits

by Kelsey Waddill

Investing in maternal healthcare may seem like a natural decision on an individual level, given the influence that positive, healthy parenting can have on a person’s life and the many healthcare needs that parents face. In reality,...

United Behavioral Health Sued for Restrictive Bundled Payment Policy

by Kelsey Waddill

United Behavioral Health is being sued for allegedly denying mental healthcare and substance abuse care claims through its bundled payment policy. United Behavioral Health administers UnitedHealth...

How Payers Help Tackle Substance Use Disorders, Other Conditions

by Kelsey Waddill

The National Quality Forum’s (NQF) Opioids and Behavioral Health committee brought together healthcare leaders from across the nation to explore an under-represented subject: strategies around substance use disorders with...

How Employers Can Control Costs with Episode-Based Benefit Plans

by Kelsey Waddill

As employers strive to help members lower costs, they can leverage episode-based benefit plans to guide their employees toward value-based care decision-making, according to a report from Manatt...

Building Payer-Provider Partnerships for Bundled Payment Models

by Emily Sokol, MPH

A bundled payment model born from a payer-provider partnership between Blue Cross Blue Shield Rhode Island (BCBSRI) and University Orthopedics has helped deliver a holistic, outpatient delivery of a...

High-Deductible Health Plans Spur Maternity Out-of-Pocket Spending

by Kelsey Waddill

The rise in high-deductible health plans due to the ACA’s lack of cost-sharing restrictions in some areas may be leading to high maternity out-of-pocket spending, researchers have...

Value-Based Care Models Gain Steam, Cut 20% of MA Spending

by Kelsey Waddill

Evidence is mounting to confirm that value-based care models are more cost-effective than fee-for-service, according to Humana’s fifth Value-Based Care Report, which said bundled payments and...

Humana Expands Bundled Payment Models for Spinal, Joint Surgeries

by Kelsey Waddill

Humana recently expanded its value-based payment models by signing four more agreements with providers for bundled payment models for spinal fusion surgeries. The payer also announced the growth of...

UnitedHealthcare Expands Medicare Advantage Bundled Payment Program

by Jessica Kent

UnitedHealthcare is expanding its Medicare Advantage bundled payment program, offering providers in more than 30 states the opportunity to participate in these models for their patients enrolled in MA...

Humana Expands Value-Based Care Options for Medicare Advantage

by Jessica Kent

Humana has announced a series of initiatives to increase value-based care for orthopedic services among its Medicare Advantage members. The organization will partner with orthopedic and neurosurgery...

HCTTF Offers Clinical Episode Grouper Resources for Bundled Payments

by Jennifer Bresnick

The Health Care Transformation Task Force (HCTTF) has released a new set of resources to support payers as they develop innovative bundled payment programs. In a white paper titled Episode Groupers:...

Narrow Network Alignment Could Drive Value-Based Payment Reform

by Thomas Beaton

Investment in high-performance narrow networks, creating new payment incentives, and leveraging digital innovation could help to increase adoption of value-based payment reform across the healthcare...

Payers See Cost, Quality Gains with Value-Based Payment Models

by Thomas Beaton

Payers and providers participating in value-based payment models are seeing reduced costs and improvements in care quality.   Value-based payment, which is expected to account for 59 percent of...

Medicare Bundled Payment Programs Primed to Produce Savings

by Thomas Beaton

Medicare’s bundled payment programs are in an opportune position to produce additional savings and create a more cost-effective public payer program with certain revisions, a new white paper from...

How Payers Can Effectively Scale Value-Based Care Networks

by Thomas Beaton

Value-based care networks are a promising opportunity for payers that want to manage costs and improve outcomes of beneficiaries.  But effectively scaling collaborative, risk-based reimbursement...

Humana Launches Bundled Payment Model for Maternity Care

by Thomas Beaton

Humana has launched a bundled payment model to improve outcomes and lower costs of maternity by partnering with OBG-YNs across the country. Humana’s Maternity Episode-Based Model bundles...

Bundled Payments Require Clinical Insights, Provider Buy-In

by Thomas Beaton

Payers see bundled payments as a way to promote value-based reimbursement practices but must first leverage clinical insights and provider buy-in to maximize a bundle’s potential...

Humana Expands Bundled Payment Model for Medicare Advantage

by Thomas Beaton

Humana has expanded a bundled payment model into seven additional states that will cover hip and knee replacements within Medicare Advantage populations. The payer has teamed up with orthopedic...

BCBS of MI Launches Bundled Payments for Hip, Knee Replacements

by Thomas Beaton

BlueCross BlueShield of Michigan has launched a pilot program that will use bundled payments for knee and hip replacements in order to manage costs and improve member outcomes. BCBS data estimates...