Despite the elimination of mandatory bundled payments by the Centers for Medicare and Medicaid (CMS), commercial insurers are investing in this model based upon the positive results they’ve seen from the CMS demonstration models and their own trial experiences.
Bundled payment models shift financial and clinical accountability to a single provider-led organization that takes responsibility for the cost and quality of care delivered for the agreed upon episode. The organization receiving the bundled payment earns a higher margin if the resource consumption for the patient is more efficient and better quality outcomes are achieved. At the same time, this provider must carry the financial risk of over utilization, re-admissions and complications of care. This transference of risk provides a significant benefit to the plan sponsor by eliminating variance in claims cost for the episodes of care being bundled. There are currently upwards of one hundred bundles currently being delivered in markets nationally.