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National Association of ACOs Fall 2018
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Scott Hewitt Discusses Progress With Bundled Payments

There has always been interest in bundled payments, and now the industry is moving toward implementing more, explained Scott Hewitt, vice president, payment strategy and innovation, UnitedHealthcare.

There has always been interest in bundled payments, and now the industry is moving toward implementing more, explained Scott Hewitt, vice president, payment strategy and innovation, UnitedHealthcare.


Employers are interested in bundled payments, but they have been tough to implement. What has been UnitedHealthcare's experience with bundled payments?

UnitedHealthcare, like CMS, like other payers, is certainly moving down the direction of bundled payments. I think that there was as an industry, there's always been interest in it. We've focused on some of the more higher cost items like transplants—transplants have been paid by bundled payments or via bundled payments for over 25 years. Now, looking at other modalities, can other modalities fit under a bundled payment arrangement? At UnitedHealthcare we are piloting several new initiatives new modalities with bundled payments. 

We're working on some cardiac procedures, some ortho[pedic] procedures, some [gastrointestinal] procedures, maternity cares—so, more than just the delivery itself looking at a more global pregnancy and then some post-delivery time. And the early results in these is phenomenal in terms of cost savings. The reason for the savings is better coordinated care. If for example, you're a surgeon—an orthopedic surgeon—you're going to get paid the same today under a fee-for-service environment whether you do something at a hospital inpatient or a hospital outpatient or a free-standing ambulatory surgery center. You're going to get the same reimbursement. Now, obviously, a hospital inpatient, doing a procedure in the hospital and they’re being admitted, it’s going to cost the payer a whole lot more, it's going to cost the member a whole lot more, but if that surgeon can move the, let’s just say a knee replacement, from the facility to a free-standing surgery center there's a lot of dollar savings there. If we share those dollars with the surgeon, now they've got a reason to move the appropriate cases into the appropriate setting.

Taking it beyond just the location of that service, what are some follow up visits? Did the surgeon not necessarily care as much about rehab or skilled nursing? But now that they have some more vested interest in it, they might make sure the member is going to the best skilled nursing facility or getting to the top physical therapist in their region. Leading to better experiences and better outcomes.

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