We’ve blogged before about bundled payment claims analytics as a means of reducing healthcare costs while improving the quality of care.
Planning and data analysis is important so that healthcare providers that agree to accept bundled payments know how to split and share that single payment. Here is an excerpt describing bundled payment claims analytics:
Accurate data is critical for a sound analysis. To begin the process, data must be grouped into bundled events, or episodes. Using inpatient admissions as the starting point, group all claims, for the same patient throughout the course of admission and for at least 90 days post discharge (a pre-admission time period may also be considered). Organize the claims into time periods (inpatient, 30 day post discharge, etc) and maintain detailed claim information, such as procedure codes, diagnosis codes and provider IDs to enable a thorough analysis of the drivers of cost throughout the course of treatment.
Once the data are grouped, review the results by admission type to identify the higher volume and higher average cost events, as displayed in the report below. Higher frequency and higher cost events may represent the greatest opportunity for savings, but this is just the beginning of the analysis. Beyond, the average cost per event, it is important to drill into admission types of interest and assess the variance in cost across similar bundled events. Care for event types with greater variance in cost may be more difficult to standardize and pose more financial risk for providers under a bundled payment contract.
Read the entire bundled payment assessment here.
Also, read this healthcare reform briefing paper entitled “Evaluating bundled payment contracting” for additional considerations for bundled payments.
You may also be interested in listening to a recording of our webinar, “Managing bundled payment initiatives using claim-based analytics“. To listen to the webinar, please click on the “Register” button, enter the requested information, and click “Complete Registration”. The webinar will then automatically stream to your computer.