Dive into Bundled Payments or Wait?

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

For Trinity, the puzzle is how to arrive at a bundled rate across providers, various clinical areas, and the system as a whole. Some financial leaders at the CFO Exchange noted that bundling across a health system is highly challenging, especially when it comes to dividing up payment. So approaching bundled payments through a specific specialty may prove more successful in the early stages of these payment models—which is why the reimbursement model between Fort Myers, Fla.–based 21st Century Oncology and Louisville, KY–based Humana is one to watch.

The partnership is intended to bundle all the procedures performed during a particular episode of care, with the goal of streamlining the claims payment process, eliminating administrative waste, and facilitating better care coordination across providers.

"For over two years, 21st Century has felt that the payment model is going to evolve. We've been working with CMS closely to pilot this [type of payment model] in the Medicare space; we had those discussions going prior to reaching a commercial agreement," says Kurt Janavitz, senior vice president of managed care and network development at 21st Century Oncology. "Rather than have this model thrust upon us and have to react to it, we decided to take a leadership position to gain the experience with it, and to use it as a differentiator for payer groups wanting to use it."

21st Century Oncology provides cancer care services across multiple modalities, is the nation's largest radiation oncology provider, and has the second-largest group of urologists in the U.S. The physician-led company operates in 16 states and seven countries, has a network of over 250 facilities, and is affiliated with over 500 physicians, including a range of specialties from radiation oncologists to other cancer-related specialists.

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