How A Buyer Has Numerous Benefit Options For The Procedure...

A buyer has numerous benefit options to choose from. The following are the suggested options: 1. A Center of Excellence (COE) Only Benefit: Under this benefit design, patients are signified to a COE for evaluation and determined to see whether they are applicable aspirants for a knee or hip replacement procedure. If the candidate qualifies for the procedure, the benefit is enclosed and the provider is paid a bundled payment. If an individual does not qualify for the procedure, there is no insurance benefit for the procedure at any facility. 2. Reference Pricing: Under reference pricing, a benefit price is established for a set of services. Some providers will bill at or below the reference price; some providers will bill†¦show more content†¦These approaches give the patient a broad choice of providers and some financial incentive – in the form of lower cost-sharing – to seek care from a provider participating in the bundled payment program. However, to create enough â€Å"steerage† to these providers, the incentives will have to be significant; providers may think twice about participating in bundled payment if patients still have a broad choice of providers. Purchasers are likely to be more successful at getting providers to accept bundled payment if providers can expect greater patient volume when they do. To achieve maximum savings and better patient outcomes by driving volume to high-value providers, CPR recommends benefit design approaches that create incentives for enrollees to seek care from them. Options 1 and 2 above are examples of benefit designs that are more likely to yield higher results than those strategies that offer modest benefit design differentials between a bundled payment provider and a non-bundled payment provider. In the end, determining your benefit design strategy comes first; designing and developing the network will follow. Employee education and benefit designs that either encourage or require the use of treatment decision support (TDS) tools can help consumers feel better about their treatment decisions and prepare them for more aggressive benefit strategies that steer patients