healthcare bundled payments

Healthcare bundled payments are a new revenue opportunity.

In 2013, the Centers for Medicare & Medicaid Services (CMS) introduced an initiative for healthcare bundled payments – Bundled Payments for Care Improvement (BPCI) – designed to help transform reimbursement models in the US healthcare industry.

In the past, providers received Medicaid and Medicare reimbursement based on the quantity of services provided to patients. Consequently, patient care was often fragmented between providers, resulting in greater costs and less-than-optimal outcomes. The CMS bundled payment program reimburses providers based on the quality of care they furnish patients, incentivizing greater collaboration and coordination of care and ideally reducing waste, lowering costs and improving patient outcomes.

To participate in healthcare bundled payments, most hospitals and health systems will need to significantly transform workflows, processes and the way they manage episodes of care. For many organizations, the technology and expertise to facilitate this transition may not exist in-house. To realize the revenue opportunities of healthcare bundled payments, these organizations can partner with a convener – an organization providing the capabilities and experience to manage episodes of care for healthcare bundled payments while also sharing risk with the organization.

naviHealth solutions for healthcare bundled payments.

naviHealth is a leader care transitions and post-acute care management, as well as one of the largest conveners for healthcare bundled payments for hospitals and health systems in the nation. We provide high-tech, high-touch care management and solutions for healthcare bundled payments to more than 50 hospitals nationwide, helping to manage approximately 40,000 episodes of care each year.

To prepare healthcare organizations for participation in the bundled payment program, we offer services that include:

  • Clinical support services, with more than 420 skilled clinicians helping to guide patients through post-acute care transitions.
  • Analytics and reporting, with tools to provide NPRA support, increase provider engagement, benchmark performance against best practices and determine areas for potential savings.
  • Scalable and proprietary technologies that impact savings levers and help to manage and track outcomes metrics in the bundled payment system such as PAC level of care, high-quality PAC networks, readmissions and SNF utilization.

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 in healthcare bundled payments.

When working with naviHealth solutions for healthcare bundled payments, organizations are better equipped to:

  • Reduce readmissions by focusing on quality of care rather than quantity of episodes.
  • Optimize financial results by lowering unnecessary utilization and 90-day episode costs.
  • Improve patient outcomes through more effective care coordination, increased physician alignment and greater patient engagement.
  • Enhance payment reform readiness with solutions to prepare for the wider shift to value-based healthcare.

Learn more about healthcare bundled payments and naviHealth.


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