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Time Has Come for Commercial Bundled Payments, Fraker Says

06/30/16

Time Has Come for Commercial Bundled Payments, Fraker Says

Caroline Fraker

The use of bundled payments in commercial settings can reduce costs and help self-funded plans rely less on networks, MedBen Vice President of Compliance Caroline Fraker commented during the "Administering Physician Claims with Bundled Payments" webinar on June 23. The webinar was sponsored by the Society of Professional Benefit Administrators (SPBA), of which Fraker serves as a board member.

"Plan sponsors are looking for lower cost and consistency while providers are looking for administrative ease and market share," Fraker said. "Bundled payment models will stimulate quality improvement and push forward alternative payment methods."

Currently used primarily to reimburse Medicare claims, bundled payments serve as a pricing "middle ground" between fee-for-service and capitation. The Centers for Medicare and Medicaid Services has set a goal that 50% of payments will originate from alternative payment models by 2018, and it's expected that private health plans will follow in turn.

Fraker noted that the transition in the commercial sector has already started. "Large employers in your communities are already experimenting with some form of bundled payment models. And because hospitals want to rid themselves of PPO network contracts, they'll likely move all services in that direction once they become comfortable with Medicare bundled payments," she said.

MedBen already has a head start on working with the bundled payment concept. Through our MedBen Analytics service, we're helping hospitals take raw Medicare claims data and convert it into actionable insights that improve quality of care, while controlling costs.

Our growing experience in this area, combined with our proven benefits administration expertise, will soon allow commercial employers to benefit from alternative payment models as well. MedBen is in the process of rolling out commercial bundled payment services to clients.

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