15 Jan Clinical Episode Contracting Guidance for Commercial Payers
About this resource
The HCTTF, under the strategic direction of its Advanced Payer-Provider Partnerships Work Group, developed this guidance document to help support payers and providers in the establishment of commercial-sector clinical episode payment contracting relationships. The guidance is generally based on the structure developed by the Health Care Payment Learning and Action Network (LAN) and identifies essential design elements and operational considerations for episode payment models to succeed. While many believe that clinical episode payment programs are complicated, the goal of this document is to create an objective tool for payers and providers to work together to make key program and contract design decisions in a logical, step-wise way. This document also includes links to key resources that can assist organizations in pursuing specific design elements.
Members of the Health Care Transformation Task Force (“HCTTF” or “Task Force”) experienced with episode payment models have identified five keys to bundled payment success:
- provider (including specialist) engagement;
- contracts with clear incentives that put providers/specialists in charge of their patients during a care episode;
- data transparency so providers can see what drives variability and where the money goes;
- focused quality metrics that are relevant to patients and providers and are easy to collect; and,
- continuous innovation.