title: Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.
abstract: One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change.
authors.affiliation: Department of Neurosurgery, Neuro-sciences Institute, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Slotkin
authors.affiliation: The Pacific Business Group on Health, San Francisco, California.
authors.forename: Olivia A
authors.initials: OA
authors.lastname: Ross
authors.affiliation: Population Health, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Newman
authors.affiliation: Population Health, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Comrey
authors.affiliation: Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Watson
authors.affiliation: The Pacific Business Group on Health, San Francisco, California.
authors.forename: Rachel V
authors.initials: RV
authors.lastname: Lee
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Brosious
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: Gloria
authors.initials: G
authors.lastname: Gerrity
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Paul
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: E Lynn
authors.initials: EL
authors.lastname: Miller
authors.affiliation: Geisinger Health System, Danville, Pennsylvania.
authors.forename: David T
authors.initials: DT
authors.lastname: Feinberg
authors.affiliation: Department of Neurosurgery, Neuro-sciences Institute, Geisinger Health System, Danville, Pennsylvania.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Toms
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D017050:Episode of Care; D006296:Health Services / Q000191:economics*; D006801:Humans; D064872:Patient Care Bundles; D058991:Patient Protection and Affordable Care Act; D012051:Reimbursement Mechanisms; D014481:United States
keywords: Cost savings; Episode of care; Fee-for-service plans; Insurance carriers; Patient outcomes assessment; Process assessment (healthcare); Workflow