Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Healthcare Bundled Payments

Humana Expands Value-Based Care Options for Medicare Advantage

March 14, 2019 - 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 practices to launch a new value-based bundled payment initiative specifically designed to provide coordinated care to Humana Medicare Advantage members undergoing spinal fusion...


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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: Key Considerations for Implementing...

Humana Expands Orthopedic Bundled Payment Program to NC, VA

by Jesse Migneault

Humana will bring its value-based orthopedic bundled payment program to 11 orthopedic specialty groups in North Carolina and Virginia.  The move follows a recent expansion into Kentucky and Indiana in 2017, and Ohio and Tennessee...

Humana Expands Medicare Orthopedic Bundled Payment Programs

by Jesse Migneault

The nation’s fourth largest healthcare payer recently announced it will be expanding its orthopedic bundled payment programs to eight new groups in Indiana and Kentucky.  The value-based care model will also offer participating...

Joint Replacement Bundled Payment Cut Costs, Maintained Volume

by Jacqueline LaPointe

A new Altarum Institute study confirmed previous research that bundled payment models for lower extremity joint replacements decreased care costs without sacrificing care quality or substantially increasing procedure volumes. In September...

Bundled Payment Model Attracts More Oncologists than Expected

by Vera Gruessner

The new bundled payment model from the Centers for Medicare & Medicaid Services (CMS) called the Oncology Care Model has shown strong participation numbers among healthcare providers with twice as many medical organizations...

Are Bundled Payment Models or Capitation the Better Choice?

by Vera Gruessner

  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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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