With the cost of healthcare continuously rising in the United States, having visibility and control over healthcare spending is increasingly important to healthcare consumers. Bundled payments for common procedures are one way to provide increased visibility into the cost of healthcare and give members the ability to make educated decisions to control spending.

What is a Bundled Payment?

A bundled payment is a single payment for all care to treat a patient with a specific illness, condition or medical event, as opposed to fee-for-service. This single payment includes not only the procedure itself, but any other related care. Rather than paying for each part of a large medical procedure separately (hospital stays, operations, post-operative therapy, follow-up office visits, etc.), bundled payments provide all stages of medical care for a specific surgical procedure at a fixed price.

When services are provided in a bundle, the focus is on the outcome, rather than the different pieces along the way. A member is paying for a fixed shoulder or a replaced knee, rather than paying a fee for every service received. The goal of bundled payments is to increase quality and care coordination.

The majority of bundled payment services are offered for orthopedic procedures, but more and more services are being offered for things like cardiology testing and other specialties.

Benefits of Bundled Payments

Bundled payments offer a variety of benefits.

Visibility

Members know upfront the total cost of getting all the care they need related to a procedure and can see how the cost varies by location—this facilitates consumerism, allowing members to shop around and choose the location that best meets their needs at a price they can afford.

Cost-savings

Employers experience substantially lower out-of-pocket expenses (up to 50% savings over standard contract rates), which gives them the option to offer financial incentives to employees who utilize providers offering bundled services. For example, employers can incentivize the use of bundled payment services by offering cash incentives to employees who utilize those services. The employer still saves money, and is able to encourage employees to make use of bundled payment services.

Better quality of care and patient support

With bundled payments, the consumer is provided with a better quality of care and patient support due to the following:

• Many bundles provide warranties, protecting the consumer against negative outcomes.
• Providers are more invested in ensuring positive outcomes with bundled payments, as they do not get paid more if the consumer has to have more visits, lab work, etc.
• The provider assumes some risk with bundled payments and, as such, offers more support to patients (ensuring that the patient is not only physically and mentally prepared for the procedure ahead of time, but also that he or she is doing their post-procedure follow-up work to provide the best chance for a positive outcome)

Benefits of HPS for Bundled Payments

The HPS network offers a variety of bundled payment services for common procedures. There are many benefits available with the HPS bundled payment:

• Concierge program—Makes scheduling appointments easier (optional and included in many bundles)

• SuperEOB^Ⓡ—Exclusively offered by HPS, the SuperEOBⓇ is a single, comprehensive, easy-to-understand, monthly statement of all in-network providers’ bills and related claims so the member only has to make one payment, regardless of the number of providers seen
• Claims process—The claims process for the client (employer) remains the same (all bundled payment costs flow through the third-party administrator and stop-loss carrier, contributing to the deductible of the stop-loss insurance). This is critical in minimizing the annual total out-of-pocket exposure for a self-insured employer
• Ability to offer cash incentives—Employers working with HPS often use a portion of their cost-savings to offer cash incentives to employees for taking advantage of bundled payment rates
• Best cost and care outcome—With HPS, the employer can work with their employee on the best cost and care outcome using bundled payments, which could also include waiving the deductible and coinsurance

With HPS, it’s possible to have bundled payments that provide access to nationally recognized, high-quality providers, while also experiencing simplified employee billing and reduced healthcare costs.

To learn more about these options and services and how to help your clients take advantage of them, contact HPS today!