McKesson Episode Management

McKesson Episode Management, a highly configurable, rules-based solution for advanced reimbursement, combines clinical support and claims transaction functions to help support full-scale bundled payment programs, promote quality care, and reduce administrative and medical costs.

Helping Navigate the Complexities of Bundled Payments for Care Episodes

Nearly 60 percent of payers have already implemented bundled payments at some level in an effort to move toward affordable, quality healthcare. But even though it’s a top method of value-based reimbursement (VBR) among health plans, it hasn’t seen widespread deployment. Why not? The labor intensity and high cost to scale a successful bundled payment program effectively will continue to hold health plans back from seeing the real financial potential of this model. Major challenges include:

  • Identifying and budgeting for target procedures
  • Defining an episode’s included and excluded components
  • Reimbursing all participating physicians fairly
  • Adjudicating and paying claims quickly and accurately in both retrospective and prospective models

McKesson Episode Management™ will help you develop and manage bundled payment programs that fit your plan’s specific needs – whether you are just starting to define your episodes, looking to make your retrospective approach more efficient, or ready to go full-scale with a prospective model. Our solution works within your current claim workflow to bring automation to both prospective and retrospective bundled payment programs using a rules-based approach. Take advantage of 22 standard episodes covering procedural, acute, chronic and other evidence-informed case rates, or tailor bundles to your specific program. Our solution gives you the flexibility to efficiently run a retrospective approach now and transition smoothly to a prospective approach when you are ready. Offerings include:

  • Retrospective bundled payment services — Let our McKesson analytics experts take on the administrative burden of helping you build your retrospective bundled payment program from scratch, or streamline an existing one.
  • Prospective bundled payment automation — Deploy the same rules and technical platform into your existing FFS workflow that we use in our retrospective service, allowing you to scale your programs by bundling claims real-time as they come in.
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