A new report on the adoption of bundled payment arrangements finds payers insisting on automating processes, a discrepancy in the speed of feedback data from commercial payers versus the Centers for Medicare and Medicaid Services, and a new appreciation among inpatient providers for the need to provide coordinated care.

The report, commissioned by the non-profit Health Care Incentives Improvement Institute and conducted by Bailit Health Purchasing, is the third annual report on bundled payment rollout in the U.S.

"We found that these payers are automating what were previously manual, resource-intensive processes and making significant investments to do so," said Michael Bailit, president of Bailit Health Purchasing and author of the study. "They're also simplifying their bundled payment methodologies to make them easier for the payer and contracted providers to administer. We anticipate continued expansion of the scope of these arrangements in terms of participating providers and numbers and types of episodes."

Among the report's other findings:

* Inpatient providers, who have historically had little knowledge of post-discharge activities, report gaining new appreciation for the need for coordinated, integrated, systematic care processes. In several instances, data have served to inspire participating physicians to become strong leaders in driving the systematization of care across the duration of the episode. For example, one administrator reported that providers were amazed to learn that the least intensive CHF DRG bundled payment assumed no post-acute services. Providers then understood that discharge to any location other than home, and any ED visit or readmission, would result in financial loss. This information solidified the providers' commitments to work closely on transitions-of-care processes with the ambulatory care manager who would be supporting the patients post-discharge.

* Providers working with commercial payers reported receiving regular (usually monthly) reports that convey cost information about each patient under the episode, and a listing of all claims associated with each patient. However, two providers participating in the CMMI BPCI reported that they have not been able to receive timely data from Medicare in the same fashion providers working with commercial payers have, due to a significant time lag (for example, in March 2014 the most recent claims provided by CMS were through September 2013).

The report, which includes interviews with seven payers, seven providers, and one organization selected as a convener, is available here.

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