Data Platform for Bundled payment

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DATA PLATFORM FOR
BUNDLED PAYMENTS
ARE YOU READY ?

B Y - A JAY K HA NDE LWA L

HEALTHCARE
PROBLEM

Healthcare cost is out of SOLUTION
control. Cost is high and quality
is poor. Make provider responsible for
complete care of patient instead of
activity. This will reduce volume
WHY , waste and in turn cost. Reward
collaboration across providers at
a) Fee for service rewards different platforms of care delivery
volume of services provided
rather than quality of various ideas to solve the problem
care, which can create
provider incentives that are - Accountable Care Organization
misaligned with those of - Patient-Centered Medical Home
both payers and patients.
- Bundled Payment Model
b) Fragmented care delivery
system. Health systems are
not one stop shop .

BOTTOM LINE
 control cost
Use services when need it, share information and use best
practices
 integrate the care delivery system
Make it like a virtual one stop shop
 restructure delivery of primary care
Focus on wellness instead of sickness

$WHAT IS BUNDLE PAYMENT ? A bundled payment (BP) provides a single, predetermined amount of money for treatment by one or more providers during an entire episode of care. An episode of care is the treatment of a specific medical condition during a set period of time. The Initiative will pay for services delivered across an episode of care—such as a fractured hip—rather than paying for each service associated with the medical issue separately.$

DEFINING BUNDLE MANAGING BUNDLE
• Price • Billing and payments
• Services to be included • Utilization
• Services to be excluded • Quality
• Risk adjustment • Financial performance
• Timeframe
• Entry and Exit criteria

DEFINING BUNDLE Episode of care

Price

Historical claims data
Historical utilization data Inclusion/Exclusion
Bundled services
Costing data Quality Measures

Payment schedule

DATA CAPABILITY FOR
ANALYSIS

- Financial Data
Ability to load claims data
Ability to detect episode of care across services
Ability aggregate cost
Ability to detect exclusions

- Utilization Data
- How many visits
- Time spent/frequency

- Risk Factor calculations
- Comorbidities
- Hospital acquired conditions
- Other comlications

TECHNICAL
CAPABILITIES
To be continued..

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1. DATA PLATFORM FOR BUNDLED PAYMENTS ARE YOU READY ? B Y - A JAY K HA NDE LWA L

2. HEALTHCARE PROBLEM Healthcare cost is out of SOLUTION control. Cost is high and quality is poor. Make provider responsible for complete care of patient instead of activity. This will reduce volume WHY , waste and in turn cost. Reward collaboration across providers at a) Fee for service rewards different platforms of care delivery volume of services provided rather than quality of various ideas to solve the problem care, which can create provider incentives that are - Accountable Care Organization misaligned with those of - Patient-Centered Medical Home both payers and patients. - Bundled Payment Model b) Fragmented care delivery system. Health systems are not one stop shop .

3. BOTTOM LINE  control cost Use services when need it, share information and use best practices  integrate the care delivery system Make it like a virtual one stop shop  restructure delivery of primary care Focus on wellness instead of sickness

4. WHAT IS BUNDLE PAYMENT ? A bundled payment (BP) provides a single, predetermined amount of money for treatment by one or more providers during an entire episode of care. An episode of care is the treatment of a specific medical condition during a set period of time. The Initiative will pay for services delivered across an episode of care—such as a fractured hip—rather than paying for each service associated with the medical issue separately.

5. DEFINING BUNDLE MANAGING BUNDLE • Price • Billing and payments • Services to be included • Utilization • Services to be excluded • Quality • Risk adjustment • Financial performance • Timeframe • Entry and Exit criteria

6. DEFINING BUNDLE Episode of care Price Historical claims data Historical utilization data Inclusion/Exclusion Bundled services Costing data Quality Measures Payment schedule

7. DATA CAPABILITY FOR ANALYSIS - Financial Data Ability to load claims data Ability to detect episode of care across services Ability aggregate cost Ability to detect exclusions - Utilization Data - How many visits - Time spent/frequency - Risk Factor calculations - Comorbidities - Hospital acquired conditions - Other comlications

8. TECHNICAL CAPABILITIES To be continued..

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