How data will empower success for bundled payment programs

Value-based care comes in many forms, but the common theme is to reward the quality of care over the quantity of care. A variety of initiatives have been floated in the past few years with the goal of promoting the transition to value.

Whatever the approach, information technology will play an important role in enabling providers to be more efficient, better manage risks and take better care of patients.

Bundled payments have been one of the few mostly well-received such value-based care initiatives. Bundled payments create a single payment around an entire episode of care, which is designed to cover the entire cost for the continuum of care around the specific course of treatment.

By creating a single unified payment, bundled payments encourage and push collaboration among all different providers. For example, success can require independent physicians, hospitals and post-acute providers to come together to assess the best means of caring for a patient. When providers need to work together, then barriers to information sharing, old competitive issues and other concerns can end up being addressed, too. Ultimately, bundled payments help to demonstrate that different providers cannot continue to operate as islands.



The approach to bundled payments garnering the most headlines is the bundled payment programs run by the Centers for Medicare and Medicaid Services through Medicare. The Bundled Payment for Care Improvement (BPCI) Initiative has been voluntary and can involve any one of 48 different episodes of care. The program is expanding as well, with a new BPCI Advanced initiative that will try to build on prior experience with the approach. Although there’s been criticism about many of CMS’ efforts at moving to value-based care, bundled payments seem to be avoiding most of the issues that have plagued other efforts.

With CMS moving Medicare in the direction of bundled payments, private insurers are also following suit. More commercial bundled payments are being created with some of the top insurance companies participating. While not necessarily a new idea, Humana recently announced the launch of maternity care bundled payments to create an episode around pregnancy. Blue Cross plans across the country have also hopped on board. Such plans have been around for a while, but it seems as though new bundles are being announced with regularity now.

Further, some bundled payments are even cutting out traditional health insurers. Large employers are directly approaching providers for the creation of bundled payments. Emory Healthcare and Walmart recently announced both bundled payments and a localized accountable care organization for a certain metro region.

All efforts with bundled payments will likely share one common element—data are essential. When constructing a bundled payment, trying to operate a program, assessing results or any other number of activities, there must be data to rely upon. Once the data are obtained, then it is necessary to be able to analyze and apply lessons learned or detect trends to address issues that could lead to failure under the bundled payment. There are many moving parts to such programs, and all sides are still learning to play in this game.

Time will tell whether bundled payments will succeed, although early results seem promising. Overall, the mantra should be to keep moving forward, keep improving and keep finding ways to provide the best possible care to patients.