We operate entire bundled payment programs on behalf of our partners, so they can remain focused on their core business.
RECRUITMENT + TRAINING
Remedy will work with an organization’s own personnel to assure readiness for the launch of a bundled payment program, or in many cases, recruit, fund and train our own staff to support a program’s roll-out.
We will expand and maintain the Care Coordination Center to support each local bundled payment program.
Typical of a governmental initiative, there are a growing array of regulatory requirements in the operation of a fully compliant program. These include quarterly submissions regarding program design, gain sharing participants, and program waivers.
QUARTERLY RECONCILIATIONS + REPORTING
We capture paid claim information, monitor CMS calculations to determine accuracy, calculate all gain sharing distributions, and report on financial and performance measures.
Contracts with all providers in a bundled payment program define relationships, outline responsibilities, assure compliance and are an important foundation in creating successful programs.
A LIBRARY OF RESOURCES
We provide analytics and forms to guide contract negotiations, a library of contracts and agreements that comply with CMS and other regulatory requirements, and benchmarking and best practice targets for contracting.
TAKE THE GUESSWORK OUT
We also provide a contracting team to support local efforts. Most of our Partners have never negotiated P4P agreements with physician organizations or post acute providers. Remedy’s team takes the guesswork out of these discussions and provides you with support in the development of your local network of bundled payment providers. We also have a dedicated team of experts to directly procure contracts with community providers who are critical to your program’s success.
Financing, Risk Pooling + Reinsurance
By bringing economies of scale and risk pooling to small and large bundled payment programs, we’re able to measure and reduce a bundled payment program’s risk level.
RISK IS THE SQUARE ROOT OF PROGRAM SIZE
Taking the insurance risk related to episodes of care involves the same principles of risk that govern regular health insurance; namely, that high volume programs, with more episodes, are generally less subject to random variance than smaller programs. Unfortunately, only a few of the nation’s largest health care organizations have bundled payment programs that meaningfully reduce the risk that a single episode won’t be financially catastrophic to a local bundled payment program.
ASSESSING SCALE ECONOMIES
Remedy’s provider partners have the benefit of the administrative efficiencies of the nation’s largest bundled payment program and the mitigation of risk afforded by our willingness to assume large amounts of risk associated with our partner’s program.
Remedy offers risk-pooling arrangements for high cost patients. This enables providers of all sizes to achieve levels of predictability typically only possible from the massive scale achieved by the nation’s largest health insurers.
NO UP-FRONT PREMIUMS OR CONSULTING FEES
Remedy is your partner in developing a successful bundled payment program. We fund the lion’s share of program development costs associated with launching a bundled payment program. We benefit from large economies of scale and only succeed if your program succeeds.
SLIDING SCALE OF RISK + REWARD OPTIONS
Remedy understands provider organizations may wish to take most--or very little-- of the underlying risk of a bundled program. So our programs enable providers to dial-up or dial-down the level of risk/reward they will achieve from a bundled payment program.