Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Bundled Payments

UnitedHealthcare Adopts Bundled Payment Model for Surgeries

January 19, 2017 - The national health insurance company UnitedHealthcare has followed the lead of the Centers for Medicare & Medicaid Services (CMS) and implemented a bundled payment model specifically for hip, spine and knee surgeries much like the CMS Comprehensive Care for Joint Replacement Model. UnitedHealthcare invested in the value-based bundled payment model in January 2017 to improve...


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UnitedHealthcare Adopts Bundled Payment Model for Surgeries

by Vera Gruessner

The national health insurance company UnitedHealthcare has followed the lead of the Centers for Medicare & Medicaid Services (CMS) and implemented a bundled payment model specifically for hip, spine and knee surgeries much like...

3 Ways Bundled Payment Models Brought Hospital Cost Savings

by Vera Gruessner

Case studies of bundled payment models show significant cost savings among hospitals and both public and private health insurers. The Centers for Medicare & Medicaid Services (CMS), for instance, invested in bundled payment models for lowering...

Prospective vs. Retrospective Healthcare Bundled Payment Models

by Vera Gruessner

When implementing healthcare bundled payment models, providers and payers have two main strategies to choose from: prospective or retrospective bundles. A prospective healthcare bundled payment model involves creating a budget when the episode...

Why Healthcare Bundled Payment Models May Expand in 2017

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have advanced bundled payment models by implementing these value-based payment structures in orthopedic and cardiac care. CMS released a finalized bundled payment model for cardiac and orthopedic...

5 Solutions for Conquering Challenges of Bundled Payment Models

by Vera Gruessner

Despite strong optimism and stakeholder enthusiasm, a new bundled payment program operated by the Integrated Healthcare Association and the RAND Corporation faced major problems and delays. A report from the Agency for Healthcare Research and...

How Healthcare Payers Could Reduce Wasteful Spending

by Vera Gruessner

For many years, the health insurance industry has been working to address wasteful spending among hospitals and medical practices. Some of the areas of wasteful spending relate to duplicative medical testing, unnecessary diagnostics, and excessive...

CMS Issues Bundled Payment Models for Cardiac, Orthopedic Care

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) released earlier this week the finalized bundled payment models for cardiac and orthopedic care including the Medicare ACO Track 1+ Model, according to a CMS fact sheet. The bundled payment...

Tom Price and His Stance on Value-Based Care Reimbursement

by Vera Gruessner

Representative Tom Price, an orthopedic surgeon, was nominated to be the next Secretary of the Department of Health & Human Services (HHS) on November 29. What does this nomination mean for value-based care reimbursement in the Medicare program?...

UnitedHealth Adopts Bundled Payment Model for Orthopedic Care

by Vera Gruessner

Healthcare payers are finding that their reimbursement totals show higher spend for hip, knee, and spine surgeries and other orthopedic care when compared to other forms of treatment. Along with the higher spend, members regularly show poor health...

Top 3 Trends Affecting the Health Insurance Market in 2016

by Vera Gruessner

Looking back at 2016, there were a number of different trends that continued to impact the health insurance market. The Triple Aim of Healthcare continues to be a major part of the ongoing reforms and trends throughout the insurance industry...

UnitedHealth Group Adopts Bundled Payment Models for Surgeries

by Vera Gruessner

The commercial payer UnitedHealth Group has begun expanding its involvement in bundled payment models. Forbes reported that UnitedHealth will be implementing bundled payment models for spinal surgeries as well as hip and knee replacement operations...

Humana Serves 63% of Members through Value-Based Care Payment

by Vera Gruessner

The future for the health insurance industry likely revolves around value-based care payment, which has grown in use steadily over the last several years. Recent healthcare reforms have centered around tracking the quality of care, reducing spending,...

Deductibles, Out-of-Pocket Healthcare Spending Rose 3% in 2015

by Vera Gruessner

Healthcare spending within the private health insurance market has grown 4.6 percent in 2015, according to a press release from the Health Care Cost Institute (HCCI). This type of growth in spending is higher than in recent years. For instance,...

How to Favorably Manage Risk in Value-Based Care Reimbursement

by Vera Gruessner

While downside risk does not incentivize providers to take part in value-based care reimbursement policies, data-driven technology and a combination of financial motivations may encourage physicians to transition to alternative payment models,...

Commercial Payers Behind CMS in Bundled Payment Models

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) have heavily invested in pursuing bundled payment models as an alternative form of payment for medical care among Medicare beneficiaries. Commercial payers, however, have been more slow to...

Why Accountable Care Organizations Should Adopt Bundled Payment

by Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) should consider allowing Track 1, 2, and 3 accountable care organizations (ACOs) to participate in cardiac and comprehensive joint replacement bundled payment models, according to a comment...

Private Payers Follow CMS Lead, Adopt Value-Based Care Payment

by Vera Gruessner

Commercial payers are following the lead of the Centers for Medicare & Medicaid Services (CMS) when it comes to adopting value-based care payment protocols. More private payers have implemented various value-based CMS programs such as accountable...

Latest CMS Bundled Payment Strategies May Need Revision

by Vera Gruessner

The Health Care Incentives Improvement Institute has found problems with some of the latest bundled payment strategies coming from the Centers for Medicare & Medicaid Services (CMS) including flaws surrounding clinic-centric control of the...

How Payers Could Meet Employer Needs in Bundled Payment Models

by Vera Gruessner

While the number of bundled payment models adopted by hospitals and payers is growing, implementation of value-based care is an innovative and modern idea that many healthcare providers are still unfamiliar with. For instance, bundled payments...

3 Key Steps for Payers to Succeed in Value-Based Care Payment

by Vera Gruessner

Commercial health insurance companies have little reason to remain attached to fee-for-service payment systems since the rate of healthcare costs continues growing and the healthcare industry as a whole is moving toward value-based care reimbursement....

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