Abstract
In a typical payment model, a health plan makes a separate payment for each service rendered by a hospital or physician. Especially for joint replacements, this approach can result in uncoordinated care across hospitals and providers, rewarding the quantity of services rendered rather than the quality. The Bundled Payment Initiative will provide hospitals the financial opportunity to coordinate care across specialties and settings in order to provide the member a better episode of care. In this project, the health plan will provide a single bundled payment per member to the hospital that would cover all services and procedures rendered by the hospital, physicians, and other health care providers during the member’s inpatient stay as well as related services up to a determined period post-discharge. The desired outcome of this care model is to incentivize hospitals to provide more coordinated, higher quality care resulting in better health outcomes for our members.
