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Related Experiment Video

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Payment reform a primer for taking on risk.

Jill E Sackman, Christen M Buseman

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    Summary

    Healthcare organizations must define populations and services for bundled payments or population health management. Collaboration among providers is essential for care coordination and demonstrating value.

    Area of Science:

    • Healthcare Management
    • Health Economics
    • Clinical Operations

    Background:

    • Bundled payments and population health management aim to reduce unnecessary care and improve patient outcomes.
    • Effective implementation requires clear definition of patient populations and covered services.
    • Managing cost and quality variations is crucial for demonstrating value.

    Purpose of the Study:

    • To outline the essential components for successful implementation of risk-based payment models.
    • To emphasize the need for provider collaboration in reengineering care delivery.
    • To highlight the importance of demonstrating both economic and clinical value.

    Main Methods:

    • This study is a conceptual analysis based on existing healthcare management principles.

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  • It synthesizes requirements for organizations undertaking bundled payments or population health management.
  • It emphasizes the collaborative nature of care reengineering across provider types.
  • Main Results:

    • Successful adoption of risk-based models necessitates defining patient populations and service scope.
    • Organizations must manage cost and quality variations effectively.
    • Provider collaboration is a key determinant of successful care coordination.

    Conclusions:

    • Defining populations and services is fundamental for bundled payments and population health management.
    • Demonstrating economic and clinical value is critical for these models.
    • Inter-organizational collaboration is vital for reengineering care delivery and achieving desired outcomes.