2iM Inteligência Médica

Bundle Payment Models

Value Delivery focused on patients with specific clinical conditions: The 2iM.Analytics platform assists in the implementation of payment models by Bundle or Episodes, where the Value component starts to be measured and rewarded. The episodes or lines of care that make up the Bundle must privilege clinical conditions of high prevalence and low variability.
Modelos de Pagamentos por Bundles

Generate a virtuous cycle in service quality

The Bundle Payment model is highly recommended by Porter and Kaplan; they argue that this modality generates a competition for Value. In other words, only providers who are really good at what they do accept to be remunerated in this way, as they can assume the risk of delivery based on Value. This generates a virtuous cycle in the quality of care.

For episodes or lines of care with clinical conditions of high prevalence and low variability

Nesse modelo, o pagamento é feito por condição clínica ou linha de cuidado, responsabilizando o prestador por todo o atendimento (serviço, infraestrutura, materiais etc.) durante o tempo previamente acordado.

No caso de um procedimento cirúrgico, ele deve cobrir todo o atendimento antes, durante e depois (por determinado período após o procedimento).

No caso de doenças crônicas, geralmente o valor definido é por um intervalo de tempo, quando as condições contratualizadas podem ser repactuadas, diminuindo eventuais desequilíbrios.

Profiles and Application Conditions

High Prevalence

Ideal model for events of high prevalence and low variability, such as hip and/or knee prostheses, some types of cancer and chronic diseases such as diabetes, asthma and others.

Negotiation

The negotiation must be done with a preferred provider, who assumes all responsibility for the care of a patient with a specific clinical condition.

What are the positive points?

  • Achieve better and more coordinated care.
  • Use of the best available clinical evidence.
  • Creation of incentives to reduce adverse events.
  • Reward providers explicitly or implicitly for the quality delivered: 1) Bonus for reaching predefined quality thresholds. 2) Improved margin by reducing readmissions and/or adverse events.
  • Create competition for Value and transparency by clinical condition, that is, patients have at their disposal the best providers, who have taken on some risks for the delivery of health based on Value.
  • Enable more robust analysis, producing real-life data, which can stimulate support from the materials and medicines industry to actively participate in the project.
  • End the "undue" direction of OPSMs, since the responsibility for purchasing and choosing the most appropriate product, material or medication is, by contract, the responsibility of the provider.
  • Allow providers to contract with suppliers through risk-sharing models, also involving them with responsibility for the quality of materials or medicines made available.
  • Align the interests of the main participants in the care process: financier, provider, patient and industry.

What are the points of attention?

  • Paying by Bundle, without adding a tool that evaluates the quality or value component, can generate undertreatment or risk selection, as in any simple prospective payment model.
  • Metrics. There must be a strong investment in system integrations (interoperability) to favor performance or Value analyzes. The data is limited; it is often necessary to implement new interfaces for data capture (such as PROMs and PREMs, for example), to review some internal data generation processes, or even to reformulate the information exchange model with the provider.
  • The contracting of this type of system can be done with many actors: payer, providers and industry, so the challenge is also in the construction of appropriate instruments for each contract.