Dive into Bundled Payments or Wait?
Calculating the bundled rate required the organization to comb through historical treatment data and arrive at an average price for each type of treatment.
"We have a large database, and we have the resources and expertise to determine what an appropriate clinical bundle should look like [when deciding on bundled rates]," says Janavitz. "That's not to say that there can't be a deviation [in a standard treatment], but we can come up with a standard treatment that's followed 85% of the time for patients, and know that the other 15% may not conform and accommodate for that."
The partners also needed to define the bundle for each treatment modality. For instance, 21st Century Oncology decided not to include things like consultations and proton therapy in its bundle.
"You don't want to make it too complicated for the payer to administer, and you also want to understand it. It's one of the simpler types of agreements we've seen, actually," Janavitz says.
Which payer to select for testing the case rate model was also a consideration. "Humana is a big payer but we do have bigger. But they're large enough to give value to the experience, but not to [financially] cripple us if it doesn't go as expected," he says.
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