For many practitioners, a bundle is either:
- One set price for cable, phone, and TV
- A myocardial conduction system
- A software program that automatically handles formatting, paginating, indexing, and collating of documents into a printable PDF.
The 2013 definition of a bundle is a replacement for fee-for-service payments and a move toward full-risk contracting. Proponents see them as an opportunity to align incentives of physicians, hospitals, post acute providers, and health plans so that all parties are working to improve quality, eliminate variation, and reduce waste. Under a bundled payment, a hospital and physicians assume the financial risk for delivering all care for one price for one patient episode over a set period — usually 30, 60, 90, or 120 days. Early bundled payment programs were designed for procedures, such as hip or knee replacements or cardiac surgery, but bundled payments now are emerging for such chronic conditions as congestive heart failure, asthma, diabetes, and cancer.
Why should doctors care? As health systems move to new payment methodologies, they are trying to enfranchise individual and employed doctors in population health and payment. With a bundle, the providers share in both the upside and downside risk. With fee-for-service payments dwindling, participating in a bundled payment is a way for independent physicians to stay solvent and for employed physicians to deliver greater value to the health system. Doctors see the writing on the wall: They know that the current fee-for-service system is not sustainable, but many are unsure how to thrive in the new systems of care. But skilled physician champions are essential to the success of these new methodologies.
In an effort to begin the educational process for all providers, the AAMC and BMJ are collaborating to create online learning resources that will support clinical teams and health systems in their transition to new payment models. BMJ has a sophisticated transactional platform, fabulous resources, and tools that reflect evidence-supported best practices in the US and the UK. It has a large educational and clinical design team with over 10 years of experience in adult learning. The AAMC has developed significant content expertise working with 10 academic health systems in preparation for Medicare’s Bundled Payments for Care Improvement.
The first series of online educational products to be offered is titled “Maximizing Value: Payment Models and Care Redesign.” It will prepare health care organizations and providers for payment system reform, as well as quality, cost, and efficiency mandates. The initial online course from the Maximizing Value suite of e-learning resources is called “Bundled Payments Essentials,” and includes online modules (accredited for category 1 CME) that can be viewed individually or as an integrated course. Designed for health care professionals—from senior leaders to frontline staff—the course will lead participants through interactive online learning modules in which the user progresses from the basics of bundled payments to design, execution, and implementation strategies. The full collection will be available in the fall of 2013, and will include additional resources such as access to evidence-based clinical guidelines, quality improvement tools, and key research articles.
I won’t discount the lingering uncertainty among many physicians feel about how new payment methodologies will affect their patients and their practices. There is still a significant gap between what the future state of health care is supposed to look like and the current physician practices that are hardwired for fee-for-service.
Confusion and distress are part of being human. Keeping the patient at the center of our decision making, we can change our assumptions, alter the context of our lives, and move the discussion from “the way things always have been” to a discussion of what’s possible. Our goal is to arm as many providers as possible with the right information and tools, so they can shape our new health care context and reality.
—Joanne Conroy, MD, is Chief Health Care Officer at the Association of American Medical Colleges. She can be reached at firstname.lastname@example.org. Follow her on Twitter @joanneconroymd.