As health insurers increasingly embrace bundled payment models, there are several best practices they should keep in mind, according to Chip Howard, vice president of payment innovation at Humana, who spoke with HealthPayerIntelligence about the insurer's experience with such initiatives.
Last month, Humana announced a partnership with orthopaedic specialty groups in Tennessee to bring a bundled payment care model to Humana Medicare Advantage members seeking hip or knee replacement. The payer established the same model in Ohio this past March, the article notes.
Transitioning from volume-based care to value-based care is not easy, Howard says, as it requires a change in infrastructure and increased reporting to make care more coordinated.
To be successful, insurers must form relationships with care providers that revolve around cultivating solutions to questions of quality and cost. That also means offering plenty of data to present to those providers in order to convince them there's a way to administer high-quality care and save money.
For its hip and knee replacements model, Howard says the insurer will make patient information available for what specifically occurred in each bundle, including readmissions and complications data on the member level.
Finally, Howard recommends gradually transitioning to a model in which providers share full accountability for "the ups and downs of the financial results," rather than immediately going to a full-value model.
To learn more:
- read the HealthPayerIntelligence article