Data Sharing is Key to Bundled Payment Success

The shift from fee-for-service to value-based reimbursement has the potential to reap huge benefits for patients, providers and payers by increasing the quality of patient care, improving outcomes and decreasing the cost of healthcare. In order for this approach to succeed, more transparency and better coordination of care between partner organizations is needed.

In bundled payment arrangements, hospitals, doctors and insurers share the risks and rewards. There are many different types of bundled payment arrangements already in play, with one of the latest examples being the Centers for Medicare & Medicaid Services’ Comprehensive Care for Joint Replacement Model, which went into effect in April.

Each partner in a bundled payment arrangement needs to understand what the other is doing so that they can provide the patient with effective and efficient multidisciplinary, integrated care. Communication is paramount, and it must be done in a timely manner. Likewise, data must be accurate, and reporting must be timely.

Herein lies one of the biggest challenges that payers and providers face in adopting bundled payment models. Inadequate data and reporting as well as incompatible or outdated technology can be major obstacles in transitioning to new reimbursement structures.

A wealth of data is available in healthcare, but the industry is not as sophisticated in data collection, sharing and analysis as some other verticals (e.g., retail), largely because there is so much fragmentation.

Ideally all partners in a bundled payment arrangement will have access to real-time data. However, just getting access to static data can sometimes be a significant hurdle. In some cases, payers and providers may be able to exchange data through a bridge. In other cases, they may consider investing in new software or other IT system upgrades.

Beyond IT limitations, a lack of in-house analytical capabilities is another obstacle that some providers and payers may have to tackle. Even if the partner organizations can access the shared data, they won’t be able to turn the data into action without understanding the meaning behind the numbers.

For example, partners in a bundled payment arrangement need the ability to control and manage patient costs. Prior to negotiating the pricing model, each organizations should have a good understanding of the patients they will be serving (age, medical history, etc.), so they can assess their risks and potential costs. For any given patient, they should be able to answer questions such as:

• Where is that patient in the cycle of care?
• What is the cost of that patient’s care?

Providers and payers considering a bundled payment model may want to seek assistance from a healthcare consultant with experience helping organizations capture and understand their data to manage their costs and find opportunities.