Helping Health Plans Navigate the Complexities of Bundled Payments for Care Episodes

Payers and providers are looking to bundled payments for episodes of care as the reform initiative most likely to deliver cost savings while improving care outcomes. The promise of bundled payment is that it creates strong incentives for all members of the care team to collaborate more effectively and align around evidenced-based care practices. This collaboration reduces treatment variation, reduces wasteful services and complications, and improves transparency across the care team.

Bundled payment pilots have reported positive results, and many studies project significant savings. However, these reform-focused programs are complex to develop and administer without the right supporting infrastructure. Automated solutions are required to apply episode definitions and bundle claims in real time for accurate payments.

Uniquely Blending Clinical Decision Support, Bundled Claims Management and Expert Services

Only McKesson enables scalable episode programs with automated, prospective bundled payments. Leveraging the proven performance of McKesson’s Total Payment™ platform, which is used by the leading health plans to return accurate claims payment decisions for approximately 74 million covered members, McKesson Episode Management uniquely combines clinical support and claims transaction functions to promote quality care, reduce administrative and medical costs, and to position plans to support full-scale bundled payment programs.

With broad flexibility to use and customize McKesson content, vendor-based models or plan-defined content, Episode Management:

• Automates episode definitions for accurate bundled payments
• Automates authorizations and episode initiation in one step
• Provides expert clinical support for coordinated, evidenced-based care
• Bundles and pays episode claims in real time, within current claim system workflows
• Eliminates manual processes and other administrative barriers
• Allows broad configuration flexibility (e.g., program and episode definition, care team members, warranty periods)
• Positions healthcare organizations to align care coordination, analytics and payments

While McKesson’s robust technology enables plans to flexibly configure the bundled payment program that will work best in their unique environment, McKesson experts are available to help ensure program success at every step, from analysis of potential and actual impacts to program set-up and strategy validation. With our expert clinical content and payment and decision management solutions, we are in a unique position to help payers and providers come together in new, more meaningful ways to achieve significant and sustainable results that benefit members/patients.

Do you want to know more about Episode Management or our other Payment Management solutions? Call us at 800.782.1334 or request more information.