NJ insurers preparing to cover value-based #8220bundled#8221 payments
So far, offering bundled, or upfront payment options is being considered by several healthcare providers in the state for breast cancer patients, including
Essentially, breast cancer treatment providers are looking to offer their patients prospective payment options, meaning that patients can make an upfront payment which would cover up to a year of treatment.
Simply stated, breast cancer has several different bundles [categories and stages of the disease] and we have a set price for each of those bundles, said
Up to now, insurance companies have been wrestling with how to cover those types of payments, but at least one of them Horizon BCBSNJ is working with Hackensack Meridian to cover upfront payments perhaps by the middle of next year for breast cancer patients.
Karp stressed that in order to make bundled payments work, there needs to be close collaboration and trust between the insurers and providers, as well as a lot of preliminary pricing data.
We now have a good idea of how to create these bundles, Karp said. We share all the data with the physicians and get input from the physicians upfront. Were working with Hackensack Meridian. Were agreeing on the data in advance; were agreeing in advance on whats included in the bundle price; we agree on the price, and then roll it out.
Karp noted that experimental treatments would not be included in upfront payment options but instead would be dealt with separately.
I think the challenge on both sides is understanding what that total cost of treatment will be, Kobylowski told
The parties want to make sure they are on the same page when it comes to the cost of care, and how much that treatment program is, and making sure that we are as accurate as possible, he said. But I think the adversarial days with doctors are over. We are being very collaborative with all of our providers.
Bundled payments represent the next step in value-based healthcare delivery, or the patient-centered practices model that is quickly making the traditional fee-based model obsolete.
Value-based healthcare is typically a system in which doctors get compensated based on the quality and efficiency of the care they provide, as opposed to getting paid for delivering healthcare in bulk. Almost all insurers and care providers are engaging in shared savings, in which providers get compensated by insurance companies on an annual basis for keeping their patients healthy in an efficient and cost-effective manner.
Included in these patient-centered practices is a focus on preventative medicine, including regular checkups and screenings, that have resulted in reducing the cost of healthcare delivery and shared savings between doctors and insurance companies, as well as lower co-payments for patients.
The background for a lot of this is the focus on patient-centered care and the wellness component of it, Kobylowski said. If we are all doing this correctly we are reducing the total cost of medical care, and that would show up in reduced premiums and lower co-pays.
The success of value-based healthcare models is beginning to show. Horizon announced last week that the number of patients in the state enrolled in its patient-centered programs increased by 50 percent to 1.5 million in 2016, and value-based payments to participating doctors increased 43 percent to just under
The insurer also claimed that its patient-centered programs, which focuses on wellness and preventative care, resulted in its members avoiding more than 2,000 emergency room visits and 600 hospital stays in 2016.
Value-based care is more than the wave of the future the waves are already crashing onto the beach,
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