Bundled Payments: Is the Effort Worth the Reward?

Bundled payments have exploded in popularity over the past several years, with thousands of providers nationwide participating in Medicare, Medicaid,and commercial bundled payment arrangements. These alternative payment arrangements can offer potential rewards to both payers and providers, but they also require substantial investment and aren’t without their own risks. In this session, we will examine the potential opportunities that bundled payments offer both payers and providers, as well as critically examine the costs associated with developing and implementing these types of arrangements. We will use case studies that include commercial payer representatives, provider representatives and an analytic perspective from Milliman's own experience. At the conclusion of this session, attendees will be able to: • Describe what a bundled payment arrangement is • Evaluate the potential effectiveness of a bundled payment arrangement in various situations • Compare key parameters of various bundled payment arrangements to determine potential opportunity for their organization

Andrew Madison, ASA

Actuary

I joined the CMS Office of the Actuary Medicare and Medicaid Cost Estimates Group (MMCEG) in 2010. Since then my work has generally focused on estimating the financial impacts of various Medicare policy changes, decomposing Medicare FFS spending growth using claims data, and National Health Expenditure projections by Sponsor.

Pamela Pelizzari

Pamela is a principal and senior healthcare consultant with the New York office of Milliman. She joined the firm in 2014.

Pamela has a broad background in integrated delivery system administration and healthcare payment reform. She has worked in both clinical and payer settings and has extensive experience in alternative risk contracting strategies.

Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies. She also has experience implementing both prospective and retrospective payment methodologies, including developing gainsharing methodologies, claims adjudication techniques, and quality monitoring programs.

Prior to joining Milliman, Pamela held a technical advisory role in the U.S. federal government. She was responsible for developing and implementing novel payment methodologies to transform healthcare delivery and payment nationwide. Previously, Pamela worked at an academic medical center, building consensus for redesigning care delivery among diverse stakeholders including physicians, administrators, and patient advocates.

Erin Smith

Director, Payment Innovation, Anthem

Erin Smith, JD, Director II of Payment Innovation at Anthem where she focuses on development and implementation of specialty payment models. Prior to Anthem, Erin was the Director of Public Policy at Cardinal Health where she serves as the lead policy expert for public payment policy and value-based care models for the Federal Government Relations group. She also led the policy arm for naviHealth, a Cardinal Health company, in which she focused on bundled payments, care transitions, and post-acute care. Prior to Cardinal Health, Erin worked at CMS in the Center for Medicare and Medicaid Innovation, leading the team that developed bundled payment models and implemented the Bundled Payments for Care Improvement Initiative. Erin served as a Medicare physician payment policy expert on the Physician Fee Schedule at CMS. She also brings experience from her time with the World Health Organization in Geneva, Switzerland, and Avalere Health.

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