AJMC October 2, 2020
Richard Freeman, MD , Joseph Coyne, DrPH , Jon Kingsdale, PhD

The relatively few examples of commercially funded condition-specific bundled payments provide insights into how to spread this alternative payment model further in the private insurance market.

Am J Manag Care. 2020;26(10):In Press

Takeaway Points

Medicare has embraced condition-specific bundled payments (CSBPs) in its Bundled Payments for Care Improvement initiatives. However, commercial insurers have been slow to follow Medicare’s lead. In our critical appraisal of the few commercial CSBP programs, we highlight these primary takeaway points:

  • Successful plans have closely aligned providers and payers who share data seamlessly.
  • Conditions, entry, and end points must be clearly defined, but attempts to control all risk by using narrow or highly stratified entry criteria fail.
  • Risk mitigation measures are necessary and most...

Today's Sponsors

LEK
ZeOmega

Today's Sponsor

LEK

 
Topics: Bundled Payments, CMS, Govt Agencies, Insurance, Payer, Payment Models, Provider, Value Based
Mandatory Medicare Bundled Payment and the Future of Hospital Reimbursement
Medicare’s New Mandatory Bundled-Payment Program — Are We Ready for TEAM?
What you need to know about CMS' TEAM payment model
CMS releases participant list for mandatory Transforming Episode Accountability Model
Integrating Maternity Care Through Bundled Payments In The Netherlands: Early Results And Policy Lessons

Share This Article