Bundled Payments

Overview

Bundled Payment arrangements have the potential to drive improvements in health care outcomes and lower costs while maintaining quality of care. A bundled payment provides a single payment to multiple providers for an entire episode of care, that is, treatment for a specific medical condition during a set period. The following resource documents, prepared by The MITRE Corporation and The Brookings Institution's Engelberg Center for Health Care Reform, are intended to help potential bundled payment participants better understand the competencies and resources required to succeed under bundled payment arrangements. You will find here several documents that are directed toward that objective; in particular:

Two resource documents, each of which will help organizations that are preparing to participate in a bundled payment program address a critical area of competency:

• A study of contractual considerations that analyzes the issues related to agreements in an environment where hospitals, physicians, and other providers will interact in significantly new ways; and
• A study of health information technology that analyzes the information management capabilities useful in an environment in which the failure to create the right information, and to move it in a timely and effective manner to a provider who depends on it, can profoundly limit an organization's ability to manage the cost and outcomes of care.

Three case studies that describe what organizations have done to develop the capabilities necessary to deliver cost-effective care in a setting where the organization bears financial risk for that care:

• A study of Crozer-Keystone Health System which describes how that system in suburban Philadelphia prepared to implement the PROMETHEUS Bundled Payment system;
• A study of Aurora Health Care which describes how that system developed the physician leadership capacity it felt was essential to the transformative initiatives that are at the core of its efforts to position itself to thrive in a value-driven marketplace; and
• A case study of St. Luke's Hospital part of the Iowa Health System, which describes how St. Luke's transformed the way it delivered care to patients hospitalized for heart failure, which care redesign was the foundation of its successful effort to reduce readmissions for these patients.

All documents were prepared at the request of the Center for Medicare and Medicaid Innovation (CMMI).