bundled payment

(redirected from episode-based payment)

bundled payment

A single comprehensive payment made to healthcare providers—hospitals and physicians—for a group of related services, based on the expected costs for a clinically defined episode of care.
References in periodicals archive ?
Comprehensive Care for Joint Replacement On July 9, 2015, the Center for Medicare and Medicaid Innovation ("CMMI") proposed an episode-based payment model for major joint replacements with mandatory participation for hospitals in 75 markets throughout the United States.
Bundled Payment: This model, also known as episode-based payment, ties provider reimbursement to clinically defined episodes of care.
They go by many names--bundled payment, episode-based payment, case rate, global payment, packaged pricing and others--but they share a common feature.
GE Ventures and Drive Capital started by 2 Silicon Valley veterans, invested in Aver due to its innovative approach to health care reimbursement with an episode-based payment model.
ACA seeks to remedy this issue; the law has launched pilots to shift to an episode-based payment system.
And there are demonstration projects showing that episode-based payment and salaried physicians work just as well and cost less.
Few studies have addressed the effects of episode-based payment on cost and quality, although there are examples of episode-based programs having positive influences on structure and process quality measures as well as decreased costs of care.
These physician survey results are broadly consistent with other empirical data presented in the working paper that demonstrate that higher quality/more efficient care episodes cost on average 14 percent less - a result that helps quantify possible savings opportunities from episode-based payment 'bundling' initiatives.
The entire Blue Cross Blue Shield System portfolio includes accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs, all aimed at rewarding quality care that is effective and efficient and that leads to better health for patients.
Galvin is also concerned about the complexity of episode-based payment.
The study findings have implications for a wide range of payment reform initiatives, including primary care medical homes seeking to coordinate their patients' care more effectively and incentivize quality and efficiency; accountable care organizations that take additional responsibility for the quality and total costs of care and for population health; and episode-based payment approaches, which is a model that pays for an entire course of treatment, rather than using the "fee-for-service" approach.
This broad portfolio of care programs includes accountable care organizations, patient-centered medical homes, pay-for-performance programs, episode-based payment programs and programs that leverage technology to provide the high quality of care for which FEP and BCBS companies are known.