Our role is customized to how much each Payer seeks to utilize our services. The full scope of our services includes:
- Program Design – We advise you on the various approaches you can take to episode definitions, program scope, target pricing and roll-out.
- Setting Target Prices – We use your own historical claims data to calculate target prices for each episode of care you wish to include in your bundled payment program.
- Technical Support – We guide you and your participating providers through the details of launching bundled payments.
- Program Administration – We calculate quarterly and annual performance and deliver a comprehensive reporting package to your plan and each of your participating providers.
- Software Platforms – Episode Connect, our Episode of Care platform, helps your contracted providers successfully manage their bundled payment programs. Your own medical management departments may also seek to utilize Episode Connect for all your high cost case management initiatives.
- Analytics – We deliver performance reporting to your plan and your participating providers, providing decision support and using information to drive change.
- Risk Sharing and Provider Assistance – Most providers are understandably nervous about the financial exposure created by taking risk in any value based program, as well as the administrative challenge of bundled payments. We create Partnerships to share financial exposure and to Convene more providers into a voluntary bundled payment program by handling the novel administrative challenges of managing episode based value payments.
Payers We Work With
Our largest customer is the Centers for Medicare & Medicaid Services (CMS), which operates the Bundled Payment for Care Improvement (BPCI) program through the Center for Medicare and Medicaid Innovation. Remedy is the largest Awardee Convener in the BPCI program, with provider Partners across the U.S. The Convener is like a General Contractor for Medicare, bringing health care provider organizations into the BPCI program under our Master Contract with CMS.
State Medicaid programs are beginning to experiment with episode based financing strategies, similar to the Medicare BPCI program. Whether those programs are centrally developed by state agencies or through contracts with Medicaid HMOs, Remedy can help these organizations build a network of contractual relationships with local and regional health care organizations to launch a bundled payment program. Remedy finances the creation of these programs, manages their development and administers the ongoing relationships and finances of a successful program.
Remedy’s episode of care programs can be utilized by M.A. Plans to address a wide variety of challenges, including:
- Management of Post-Acute Care
- Improvement of HCC Scores
- Member Retention
- Launch of Bundled Payments
- Improvement of Quality Scores
Remedy can work within existing provider network arrangements or create entirely new contractual networks for managing bundled payment programs. Remedy’s approach is customized to the unique characteristics of each local health care market. We rely on engaging providers in new ways of working together to closely manage transitions of care and create a successful care team around each patient. Our services can be the Complete Outsourced Solution or payers can utilize elements of Remedy’s Products + Services to achieve targeted outcomes.
Bundled Payments for episodes of care represent a transformative platform for building benefit plans, organizing networks and bending the cost curve for health care services. Bundled Payment Programs for costly diseases and interventions help align health care providers to work collaboratively to achieve improved quality, lower costs and better outcomes. This patient-centric strategy also helps improve member satisfaction and retention.
Bundled Payments are superior to narrow networks as a strategy for delivering greater benefits at lower prices. Bundled Payment programs can achieve larger cost savings than narrow networks, while having a dramatic impact on Member engagement in the challenge of controlling health spending. Remedy can help you design benefit plans that harness the power of bundled payments in your commercial insurance offerings.
Bundled Payments can be integrated into the benefit designs of self funded employers, to encourage employees and their dependents to take a more active role in managing health care spending. Benefit designs can provide rewards to employees for utilizing Bundled Payment Care Teams who have agreed to deliver a range of services for a pre-determined price. The team at Remedy has also helped design benefit structures that use Episode Allowances, a sort of ‘budget’ inside your benefit plan for certain episodes of care. This creates a powerful incentive for employees to utilize Bundled Payment Care Teams.
Ask us how we can help lower your employee health costs while getting your employees more involved in managing costs.