Recent CMS rule changes have once again brought bundled payments into the national spotlight. Addressing established uncertainty amongst payers and providers on the future of bundled payments, Chilmark’s latest report analyzes the market trends shaping this space and describes available health IT solutions to help healthcare organizations (HCOs) adapt to these new value-based payment programs.
Challenges to Bundled Payment Programs
The report, Bundled Payments: Current Strategies and Tools, starts by shedding light on the challenges that have plagued efforts to implement these payment models. This includes questions about how smaller-scale HCOs will adapt to increased collaboration requirements, to what extent actual cost savings can be realized through bundling, and concerns about the efficacy of existing IT solutions for enabling the payment models – technology that is essential to actually make these models realistic for providers to adopt.
Payer Motivation to Explore Bundled Payments
The latest report reveals that despite these very real concerns, payer motivation to explore bundled payments as a solution to rising healthcare costs remains high. Chilmark’s research illuminates why and how HCOs need to prepare to meet the increased patient engagement and collaboration requirements – as well as the opportunities here – demanded by the bundled payment model.
Bundled Payments = Market Disrupter?
In addition to providing context into how bundled payments might serve as a market disrupter, the report examines how existing health IT solutions can limit this disruption. Since no vendor currently supplies a comprehensive solution for handling the intricate requirements of bundled payment programs, providers are forced to assemble a solution from various components of other tools.
Key Vendors Highlighted
The report also looks to the future and identifies likely candidates for supplying a comprehensive solution once the market demands one. Eighteen vendors were profiled for this report, divided into five categories: Acute EHR, Care Management, Consultants, Medical Devices, and Niche Episodic Payments. Each of these 18 vendors is ranked according to their functionality in providing the following services: Opportunity Analysis, Episode Definition, Quality Reporting, Cost Reporting, Contract Management, and Reconciliation, Patient Engagement, Care Navigation Workflow, and Clinical Pathway Support. By looking at these components, the report assesses the market’s progress toward developing a general-purpose bundled payments offering for provider organizations.
State of HCO’s Ability to Adopt Bundled Payment Programs
Payers will find the report valuable for intelligence on the state of HCOs’ capacity to comply with mandated and voluntary bundled payment programs. Insight into the challenges providers face will allow payers to better address providers’ reticence in adopting bundled payment models. For providers, the report emphasizes short- and long-term strategic planning as it relates to investment in IT infrastructure necessitated by bundled payments. Consultants, investors, and government officials will also be interested in the report’s strategies and market trajectory for IT tools.
According to Matt Guldin, lead author of the report:
“Over the past several months, CMS has signaled renewed interest in bundled payments including the possibility of additional mandatory participation for oncology and other providers. This has forced providers to reevaluate their strategy including the processes and technologies they have in place to reduce risk to their revenue streams as bundled payments become more ubiquitous.”