Data analytics vendor Aver Informatics has worked with insurers and employers wanting to better understand bundled payments strategies, and now the Columbus, Ohio-based company is targeting providers as well.

The key with insurers and employers has been to help them design bundled payment programs that providers will actually accept, says Elaine Daniels, director of network strategy. Aver runs analyses on a payer’s data warehouse to assess such factors as key provider partners to recruit to have enough utilization, average costs, where unnecessary services are being rendered, areas of waste and common complications, to help determine what a budget for a future bundled payments program might be. Payers want their margins to stay the same or even increase while complications and costs go down.

Also See: MD Anderson, UnitedHealthcare Launch Bundled Payment Pilot

“We are a services company as much as analytics,” Daniels says. “There are a lot of payers who want to get in this space, but they don’t have a high enough comfort level and that’s where we help.”

Providers, on the other hand, want decent reimbursement levels, but they also want help better understanding where patients are getting care and how to retain them, and how to cut their own costs. A payer can attract providers for a bundled payments program by having Aver run monthly reports on the payer’s own data to show where patients are going for treatment and whether they are going outside the hospital or practice to get it.

Analytics also can help providers show patients the benefits of participating in a bundled payments program, such as lower out-of-pocket expenses, post-surgical treatment covered at 100 percent, and a care therapy nurse, while impressing on patients that they must be willing to have all services handled by a single provider or a group of bundled providers. “That’s where you prevent any leakage to out-of-bundle providers,” Daniels says.

Other analytics programs can help both payers and providers better understand the true costs of an entire episode of care, such as a knee replacement. The analysis looks at the care continuum from 30 days prior to surgery to 90 days post-discharge, examining all needed services. For a knee replacement, this could include home health, physical therapy, skilled nursing, a complication and the need to see a specialist.

Aver builds the reports and clients run the actual queries, with the vendor available to help walk through results if desired. Organizations getting into bundled payments and other new reimbursement models can run their own analytics programs and many do. But Daniels cautions that while possible, many others will find the task extremely time-consuming.

What providers most need when moving to bundled payments, however, is solid senior leadership buy-in to accept and manage the bumps ahead, Daniels advises. “This is a very disruptive model for payment.” For instance, organizations will need to hire one or more care coordinators. “We recommend up front that they do that, and some think they don’t need it and soon learn as lack of coordination can bring complications.”

There also are issues in patient homes that need to be considered by coordinators, such as if walkways are clear in the winter and if a large dog that likes jumping up on people needs to be boarded for a few days while in-home care is given.

Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access