Top 10 Smart Strategies for Success with Bundled Payments


Earlier this month, Health and Human Services Secretary Sylvia Burwell updated the Centers for Medicare & Medicaid Services’ (“CMS”) timeline for moving fee-for-service to “alternative payment models” – the goal is to have 50 percent of Medicare fee-for-service payments be linked to “alternative payment models”by 2018. For the past 18 months, employers and commercial payers have explored bundled payments, one of the alternative payment methods, with more than 6,000 participants signed on to participate in testing and scaling bundled payments with Medicare in the BPCI program (Centers for Medicare & Medicaid Innovation, 2015). The evaluation of such tests will inform precisely how bundles will roll out nationally.

Conceptually simple with a relatively low entry point, it is no surprise that when considering the alternatives, healthcare organizations and physicians are enthusiastically test-driving bundled payments. Looking to avoid the “head in the sand” or “do nothing” approach but not quite ready for population risk, many healthcare executives view bundled payments as their middle game on the path to fusion reimbursement. Bundles can be a reasonable approach to fending off competitors and new entrants while introducing the organization and market to their new future. With bundles in pediatrics, newborn delivery, outpatient services, chronic disease, and oncology, bundled payments have moved far beyond the version 1.0 elective procedures.

If bundled payments are your preferred strategy, make sure you have a smart approach to execution. Here are the top 10 success factors to the latest in bundled payments:

1. Establish a culture of doing. Innovation is about doing. Healthcare organizations that can adopt a start-up culture will triumph in a time of payment reform and industry transformation. The pace is intense but necessary, and like a muscle that needs developing, your team will adapt. Implementing bundled payments and other alternative payment models is highly doable but does take discipline, and it will surely be disruptive. Smart leaders understand and prepare their team to rise to the challenge with a start-up attitude.