Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Bundled Payments

Are Bundled Payment Models or Capitation the Better Choice?

January 30, 2017 -   Today, healthcare payers have multiple ways to reimburse providers for performing medical services that move away from the traditional and more costly fee-for-service reimbursement system. Two such possibilities include capitation payment and bundled payment models. Capitation payment is based on targeting population health management, according to the Harvard Business Review....


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CMS Bundled Payment Models Lead to Greater Patient Selectivity

by Vera Gruessner

What are some of the biggest problems around bundled payment models and value-based care causing difficulties for physicians? According to Corporate Director at Willis-Knighton Health Systems Chris Mangin, the Comprehensive Care for Joint Replacement...

How CMS Alternative Payment Programs Impact Healthcare

by Vera Gruessner

Over the last five years, the Centers for the Medicare & Medicaid Services (CMS) has released many new payment systems for Medicare providers including shared savings, pay-for-performance programs, and bundled payment models. The alternative...

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...

How 3 Healthcare Insurers Expand Value-Based Care Payment

by Vera Gruessner

National health plans are leading the way in alternative reimbursement structures such as bundled payment models and shared saving programs. Blue Cross Blue Shield health plans, Cigna, and UnitedHealthcare have worked to expand their value-based...

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...

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...

UnitedHealthcare Cut Costs through Value-Based Care Programs

by Vera Gruessner

Last month, UnitedHealthcare released a report outlining the benefits of value-based care programs. The report called Collaborative and Coordinated: How Value-Based Care Programs are Driving Improvements in Quality and People’s Health began...

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...

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...

Why Reviewing Pricing Trends is Key for Bundled Payment Models

by Vera Gruessner

When payers begin to adopt bundled payment models, they may find some challenges standing in their way to truly succeed within these alternative payment solutions. For example, when attempting to contract through bundled payments, it may be difficult...

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...

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...

How Maternity Care Home Model Reduces Premature Birth Rate

by Vera Gruessner

The healthcare industry has often found it problematic and costly to manage the health of newborns and mothers of preterm births. There have been social problems among pregnant women that have led to higher rates of preterm births such...

CMS Bundled Payment Models Cut $864 for Orthopedic Care Episode

by Vera Gruessner

Yesterday, the Centers for Medicare & Medicaid Services (CMS) released a report encompassing the second annual evaluation of the Bundled Payments for Care Improvement initiative, according to The CMS Blog. This summer, a new proposal was...

Healthcare Bundled Payments Hinder Skilled Nursing Facilities

by Vera Gruessner

How are skilled nursing facilities and other post-acute care centers handling the transition to a value-based care reimbursement environment? Fitch Ratings stated in a press release that many post-acute care providers are finding it difficult...

Why Bundled Payment Programs Could Benefit Mammography Services

by Vera Gruessner

Bundled payment programs have been used in a wide variety of medical treatments and diagnostics such as joint replacement therapy and, more recently, cardiac care. The Centers for Medicare & Medicaid Services (CMS) has established these bundled...

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