RemitDATA_Alternative_payment_infographicWe hear story after story about patients receiving financially devastating medical bills. If only they knew how much the cost of a procedure can vary, perhaps they could make a more informed decision.

Unfortunately, it’s not that simple. Part of the problem has been traditional fee for service pricing models. Factor in complex payer/provider contract rates and little transparency or consistency from patient to patient, and you have a recipe for potential financial disaster.

With the Affordable Care Act targeting how healthcare is organized, delivered, and paid for, alternative payment models are taking shape – including bundled pricing. As payers begin to invest in implementing more bundled payment initiatives, comparative analytics can help guide them toward the greatest opportunities to impact cost of care.   By examining historical claims data, payers can identify their highest volume and highest cost procedures (grouped by episode of care) to establish actual prices. By applying these pricing methodologies, payers can reduce costs with a consumer-driven model that focuses on value-based choices.

The need for Alternative Payment Models

  • Bundled pricing shows great promise
  • Minimize sticker shock
  • Give members transparency around true costs

Factors to consider around Alternative Payment Models

  • Provider willingness to embrace risk/reward models
  • Ability for providers to collaborate amongst themselves & effectively manage payment distribution for episodes of care in a coordinated fashion
  • The alignment of plan benefit designs that encourage members to use providers in bundled payment arrangements. 

Alternative payment models allow for bundled pricing models that can drive significant change in the industry through a lower cost of care and improved outcomes!

Learn more about the future of alternative payment models and what is in store on EMR & EHR’s website. 


How can our data, combined with yours, help you evaluate Alternative Payment Models?

Request a demo and we can show you the power available in big data reporting and comparative analytics!