payment reform readiness

Payment reform readiness requires new technology and support services.

As the US healthcare industry continues its fundamental shift from fee-for-service to value-based reimbursement models, payment reform readiness has become a top priority for healthcare organizations everywhere.

Payment reform readiness begins with the opportunity to participate in value-based programs, such as the Bundled Payments for Care improvement (BPCI) initiative. Introduced by the Centers for Medicare & Medicaid Services (CMS) in 2013, the bundled payment program changes the way organizations qualify for Medicaid and Medicare reimbursement. Rather than rewarding providers on the volume of services they furnish to patients, the bundled payment system reimburses based on quality of care and patient outcomes.

The CMS bundled payment program is an initial step in what is expected to be an industry-wide shift to value-driven healthcare and payment reform. To participate in healthcare bundled payments and other value-based reimbursement models, healthcare organizations will need to make some significant changes in the way they manage episodes of care. Payment reform readiness will require organizations to improve patient outcomes through greater care coordination, enhance communication between providers and patients, and automate and standardize workflows and processes – especially in care transitions and post-acute care management.

That’s where naviHealth can help.

Payment reform readiness solutions from naviHealth.

For health systems and health plans focusing on payment reform readiness, naviHealth provides clinical services, scalable technologies and advisory solutions that help to optimize financial, clinical and quality outcomes. As a Cardinal Health company, naviHealth has been a pioneer in care transitions for more than 18 years and is uniquely positioned to help organizations with payment reform readiness.

To help healthcare organizations participate in BPCI and to improve payment reform readiness overall, we offer:

  • Clinical support services, with more than 420 skilled professionals who can help to steward patients to the most appropriate post-acute care setting.
  • Expert analysis of complex claim data sets to determine potential areas for cost savings.
  • Advanced analytics and reporting that help to optimize operational efficiencies and elevate performance against outcomes metrics.
  • Scalable technologies that help to automate tasks, streamline workflows, improve communication and enhance network relationships.

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 for payment reform readiness.

When working with naviHealth to increase payment reform readiness, healthcare organizations are better equipped to:

  • Improve patient outcomes through greater care coordination and physician alignment.
  • Lower the cost of providing post-acute care.
  • Reduce hospital readmissions, lower length of stay (LOS) and reduce waste.
  • Prepare more effectively for the broader shift toward value-based reimbursement.

Learn more about payment reform readiness with naviHealth.


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