Jean DrouinThere has been much discussion recently surrounding the future of bundled payments, focused in part on whether these new payment models are here to stay and how long it will take for provider organizations to scale these models. Forward-thinking providers and insurers have moved beyond the debate. Instead, they are actively developing the new mindsets and capabilities required to succeed in a value-based world. Indeed, the early adopters are fully embracing the potential for value-based arrangements involving payment bundles to drive better patient journeys while bringing in additional volume and margin.

The reason for this activity is that it has become apparent that the adoption of bundled payments will soon accelerate in several markets around the country.

Here’s what we’ve seen in recent months:

  • Despite the change in administration following the November election, the foundational ideas behind episode payment models remain firmly in place. The BPCI initiative is expected to move forward while the Comprehensive Care for Joint Replamcent (CJR) model, though likely to be scaled back, remains in force
  • Hospitals and physician groups are proactively reaching out to insurers and employers in an effort to enter commercial bundled arrangements
  • Bundled payments are now a common feature of the agendas at professional meetings, particularly in specialties such as orthopedics, oncology, and cardiology.

Accelerating the Pace of Change

Despite this growing momentum, the path to value is paved with roadblocks. Healthcare providers need new capabilities and tools to manage episodes of care and thrive under value-based payment models. This work demands a different approach and mindset; bundles necessitate a data-sharing system across multiple care sites far beyond the confines of the hospital’s electronic health record (EHR). Providers also need access to richer data and insights to help optimize their performance. Much attention has been given to retrospective analytics, but there is a strong need for predictive analytics as well, at both the physician and patient levels.

Advanced analytics can allow healthcare organizations to accomplish the following:

  • Understand variations in care workflows at the patient, clinician, and facility levels, enabling clinicians and care delivery partners to improve their performance
  • Prescribe precise and personalized care journeys by risk-stratifying every patient, producing a transparent care map that everyone can plan against from pre-op through full recovery
  • Monitor and coordinate care in (near) real time, identifying and addressing issues before or as they occur
  • Create a common yardstick from which to benchmark costs and measure success aligning all stakeholders

There is still time for savvy organizations to get ahead of bundled payment models and take full advantage of the growth opportunities that come with them. Those that wait risk being left perilously exposed in a world where 50 percent of providers will have higher-than-average costs. Organizations that prepare will be in a better position to negotiate and compete for volume.


Jean Drouin, MD, MBA, is CEO and founder of Clarify Health Solutions, San Francisco.

Publication Date: Monday, September 11, 2017