cms bundled payment

Revenue opportunities in the CMS bundled payment program.

The bundled payment program from the Centers for Medicare and Medicaid Services (CMS) represents one of the most sweeping changes in the US healthcare industry. Rather than offering Medicaid and Medicare reimbursement based on quantity of services, the Bundled Payments for Care Improvement (BPCI) initiative rewards providers for the quality of care delivered to patients.

The CMS bundled payment program is a shift away from the traditional fee-for-service model that has led patient care to be frequently fragmented and increasingly expensive. By incentivizing physicians to coordinate care more effectively, the CMS bundled payment system is helping to reduce waste and unnecessary utilization, lower the cost per episode of care and improve patient outcomes across the continuum.

By 2018, CMS intends to have half of all payments tied to alternative payment models like the CMS bundled payment program, representing a significant revenue opportunity for hospitals and health systems who are ready to participate in healthcare bundled payments. But for many organizations, managing care episodes for CMS bundled payment will require technology and expertise which may not be available in-house. For these organizations, partnering with a convener like naviHealth can be a valuable strategy for taking advantage of the opportunities the bundled payment program offers.

Simplifying the CMS bundled payment system with naviHealth.

naviHealth is the largest CMS bundled payment convener in the nation, providing high-tech, high-touch care management solutions to more than 50 hospitals and helping to manage approximately 40,000 episodes of care annually.

As a convener, we not only provide the capabilities and expertise required to participate in the CMS bundled payment program, but we also share risk with our partners in managing episodes of care under this new reimbursement system.

Our offerings include:

  • Scalable technology to improve care coordination, reduce costs and manage metrics such as high-quality PAC networks, PAC level of care, SNF utilization and hospital readmissions.
  • Advanced analytics and reporting for NPRA support, increasing provider engagement, benchmarking performance and identifying targeted areas for savings.
  • Clinical services with more than 420 clinicians available to help steward patients through post-acute-care.

An Experienced Partner

We’ve spent more than 18 years pioneering ways to improve every aspect of care transitions for health plans, providers and patients. From discharge planning efficiencies to managing risk for payors and providers, naviHealth is equipped to provide you with a tailored suite of capabilities.

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Benefits of partnering with naviHealth on CMS bundled payment reimbursement.

Organizations that navigate CMS bundled payment opportunities with help naviHealth are empowered to:

  • Improve patient outcomes through investment in capabilities for more effective post-discharge care coordination.
  • Enhance the patient experience by engaging patients in their own care plan, providing higher quality care and developing more meaningful interactions.
  • Reduce readmissions by aligning and engaging physicians more effectively.
  • Optimize financial results by minimizing unnecessary utilization, lowering 90-day episode costs and reducing the overall cost of providing care.
  • Increasing payment reform readiness with solutions that lay the groundwork for participating in the industry-wide shift to value-driven healthcare.

Learn more about naviHealth and the CMS bundled payment program.

The statements contained on this page are solely those of the author and do not necessarily reflect the views or policies of CMS. The author assumes responsibility for the accuracy and completeness of the information contained on this page.

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