Mitigating Risk On Outpatient Bundled Payment Contracts

Public and private payers have been redesigning reimbursement models as the industry is shifting to value-based care. New models like bundled payment not only stress on accountability but also on reducing healthcare costs. According to the industry experts, bundled payment model will help in defining the future of revenue cycle management. It will embrace value-based care without putting providers in the downside financial risk contracts.

Recently, there has been a rise in the number of commercial plans looking to the outpatient specialty market to apply the same bundled payment methodology. The idea is to bring high cost services in line with less expensive approaches. Even though it can prove to be an effective method, it becomes necessary for practices to manage opportunities of bundled episodes of care.

Here are some of the methods that can be taken into consideration to mitigate the risks on outpatient bundled payment contracts:

  • It will help if costs are controlled as much as possible. For instance, if a gastroenterologist owns an ASC and has his own lab, it will be easier for him to control costs. But if not, then he will have to share risks with a hospital partner and choose to work with in-network resources. This will help in mitigating the risks and lowering costs.
  • To minimize adverse events and keep costs in check, patient care will have to be managed and co-ordinate effectively. However, it will not be an easy thing to do when complicated procedures are involved or when multiple providers are involved.
  • Another effective method to mitigate the risks of bundled payment contracts is to manage the data in an effective manner. Monitoring physician performance and acting upon the collected data is equally important. This will help in ensuring that the highest level of care is being delivered. Most bundled arrangements have quality metrics associated with them. It will help to partner with effective vendors, self-funded employers and health plans in order to implement bundled arrangements in an effective manner.

For providers, to be successful in bundled payment systems, sufficient infrastructure and expertise will be needed. In some cases, providers also partner with a large physician organization or institution that has the expertise because creating administrative expertise from the scratch can be difficult. But in such cases, providers need to ensure that the partner and they have common goals.



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