Why Reviewing Pricing Trends is Key for Bundled Payment Models

Guidehouse Published in HealthPayer Intelligence

What solutions should providers and payers follow when certain costs are out of their control within bundled payment models?

Guidehouse’s Rich Bajner shared his perspective with HealthPayer Intelligence on some of the obstacles payers face when adopting bundled payment models:

“Based on our experience facilitating payer-provider bundled payment contracts in the commercial market, the biggest challenges are analyzing historical claims that originate from multiple datasets to understand historical prices and set target prices [along with] modifying claim payment processes and systems to pay bundled payment claims. As such, most payers are not changing their claim payment process and are instead following CMS’ example to pay claims how they have historically and settle retrospectively.”

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