Looking to evaluate your vendor’s bundled payment program?

This Reform Evaluation Framework (REF) evaluates the impact of a vendor-administered bundled payment program. For the purpose of this tool, a vendor-administered bundled payment model is a program under which episodes of care are carved away from the purchaser’s primary health plan/third party administrator (TPA), and assigned to a vendor who pays providers a lump sum for the duration of treatment. Impact is measured by comparing members who received care through the bundled payment vendor to a group of plan members who received the same type of care outside the vendor’s program. This report allows the purchaser to select from 7 of the most commonly bundled episodes of care.

CONTENTS 

1. Definitions: Provides definitions of terms, cost and quality measures
2. Bundle Report – Purchaser and Book: Worksheet for evaluating impact of the bundled payment program on purchaser’s members, and for the vendor’s book of business

By using this tool you will learn:

How cost, quality and experiential outcomes compare for the following groups:

• Members who undergo an episode of care through a vendor-administered bundled payment program
• Members who undergo an episode of care through the purchaser’s primary health plan/TPA
• The vendor’s population/geographically-adjusted book of business
• The estimated savings that accrue from avoidable procedures (if vendor offers a separate bundle for evaluation/2nd opinion services)