2017 hcbpc lg

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Monday, November 13, 2017 • 5:30 p.m. – 7:30 p.m.

The Evolution of Bundled Payments – Negotiating and Implementing Bundled Payment Agreements from the Ground Up

Bundled payments have maintained their popularity as an alternative payment model that can be implemented by a wide variety of different payers and providers and across a range of clinical conditions. However, there are many nuanced considerations that an organization must face when designing and implementing a bundled payment arrangement.

In this interactive workshop session, we will cover the different types of arrangements that must be carefully considered, drafted, and negotiated, both between payers and risk bearing providers and between the primary risk-bearing entity and any gainsharers. The discussion will be relevant to both Medicare and commercial arrangements.

Participants will leave this session with an understanding of:

  • How CMS and other payers’ use of bundled payments has evolved in recent years
  • Key design features of financial constructs and episode definitions relevant to payer – provider contracts
  • How to structure and negotiate gainsharing agreements
  • Implementation considerations for bundled payment contracts

Pamela Pelizzari, MPH is a Healthcare Consultant with the New York office of Milliman. She specializes in the development and management of value-based payment arrangements. Pamela has particular expertise in analysis of healthcare claims and the development of episode-based payment definitions and benchmarking methodologies. She also has experience implementing both prospective and retrospective payment methodologies. Prior to joining Milliman in 2014, Pamela served as a technical advisor at the Centers for Medicare & Medicaid Services (CMS), responsible for developing and implementing novel payment methodologies to transform healthcare delivery and payment nationwide. Pamela played a key role in designing the national Bundled Payments for Care Improvement initiative, with thousands of participants nationally. Previously, Pamela worked at an academic medical center, building consensus for redesigning care delivery among diverse stakeholders including physicians, administrators, and patient advocates.

Erin Smith, JD is the Vice President & Executive Director at the Post-Acute Care Center for Research. Ms. Smith served as the Director of the Division of Technical Model Support at CMS in the Center for Medicare & Medicaid Innovation, where she led the team that implements the Bundled Payments for Care Improvement initiative and developed new bundled payments models. She also worked as an analyst focused on payment under Medicare's Physician Fee Schedule. Prior to CMS, Erin was a regulatory and policy analyst specializing in tobacco control at the World Health Organization in Geneva, Switzerland. More recently, Ms. Smith served as a Senior Manager at Avalere Health, where she provided strategic insights into Medicare fee-for-service payments and innovative payment policies, with particular insight into the development and operationalization of alternative payment models, such as Accountable Care Organizations and bundled payments.