With the cost of healthcare continuously rising in the United States, having visibility and control over healthcare spending is increasingly important to healthcare consumers like you. Bundled payments for common procedures are one way to gain increased visibility into the cost of healthcare and have 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. You are 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

You (the patient) know upfront the total cost of getting all the care you need related to a procedure and can see how the cost varies by location—this facilitates consumerism, allowing you to shop around and choose the location that best meets your needs at a price you can afford.

Additional cost-savings

Employers often choose to offer financial incentives for utilizing providers offering bundled payment services. For example, your employer may choose to offer cash incentives to employees who utilize those services.

Better quality of care and patient support

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

• Many bundles provide warranties, protecting you against negative outcomes.
• Providers are more invested in ensuring positive outcomes with bundled payments, as they do not get paid more if you have 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 you are not only physically and mentally prepared for the procedure ahead of time, but also that you are doing your post-procedure follow-up work to provide the best chance for a positive outcome)

Benefits of HPS for Bundled Payments

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

• 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 you only have to make one payment, regardless of the number of providers seen
• Potential cash incentives—Employers working with HPS often offer cash incentives for taking advantage of bundled payment rates
• Best cost and care outcome—With HPS, the employer can work with you 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 billing and reduced healthcare costs.

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