Humana, FL Physicians Group Bundle Radiation Services
21st Century has invested two years in the development of its bundling strategy. It worked with the Centers for Medicare & Medicaid Services to craft and refine a small number of treatment bundles for radiation therapy.
Among the challenges has been meeting payer expectations for reporting and transparency. The CMS experience helped the company sharpen its focus on delivering the specific measures and outcomes that payers want to see.
"The payer is looking for economic relevance," Mantz notes.
Based on its successful efforts with CMS, the company reached out to a number of commercial payers to replicate the bundling model. The Humana contract is the first result of that effort. Plans call for expanding the model to additional insurers.
As part of the Humana contract, 21st Century will track outcomes related to following the clinical care paths developed as part of the bundles. Mantz explains that each bundle includes radiation therapy services that have been identified as best practices through medical literature and consensus guidelines published by groups such as ASTRO, the American Society of Radiation Oncology.
- New G-Codes to Pay Doctors for Broad Array of Non-Face-to-Face Care
- CMS Sets 2014 Pay Rates for Hospital Outpatient and Physician Services
- States Rejecting Medicaid Expansion Forgo Billions in Federal Funds
- Douglas Hawthorne—A Chance to Do Something Big
- Telehealth Improves Patient Care in ICUs
- Why You Should Involve Patients in Nursing Handoffs
- Hospital M&A Volume Up, Value Down in 3Q
- 50 Years of Fighting Pressure Ulcers Called Into Question
- The 5 Biggest Healthcare Finance Trouble Spots
- Nonprofit Hospital Outlook 'Negative' in 2014