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Dive into Bundled Payments or Wait?

Karen Minich-Pourshadi, for HealthLeaders Media, October 15, 2012

Janavitz explains that the organization has spent over 30 years delivering advanced integrated cancer care, but a little over five years ago some payers began to push for more tightly managed cancer and radiation benefits. As these payers scrutinized providers' decisions around treatment modalities offered to patients, paperwork for both providers and payers increased and payments were slowed or decreased.

"There was a lot of micro-managing of benefits. Payers spent a lot of time looking at each action that was delivered, and a lot of clinical time was being spent providing supporting evidence around why we were doing a specific treatment. It was administratively burdensome for everyone," says Janavitz. 21st Century Oncology wanted to decrease the burden and ensure that its patients received treatment based on clinicians' recommendations rather than payers' reimbursement policies.

"We're experts for treatment, so we said we should come up with the right overall [payment] rate, and then that gets the nonsense out of the process of delivering care to the patient. The cash flow is up-front as opposed to claim-by-claim. We decided to do this as a national case rate contract as opposed to doing a different contract for each of Humana's individual markets," he explains.

Humana opted to partner with 21st Century Oncology for similar reasons. "We believe this partnership can improve administrative efficiencies with healthcare providers in Humana's national network," said Bill Barnes, Humana's vice president of national contracting, in a press statement.

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