Curbing Healthcare Costs Through Bundled Payments

An article by Archway Health Founder & CEO Dave Terry titled “Curbing Healthcare Costs Through Bundled Payments” was recently published on the Healthcare Financial Management Association (HFMA) blog. "With a new president and Republican-led congress, a dramatic change to the healthcare landscape is imminent. Whether the Affordable Care Act is repealed entirely or drastically reshaped, the reality is that the cost of health care is a real issue that must be addressed," Dave says.

He says that a basic problem with many current health plan solutions is that they generally combine primary care access, true insurance, and specialty care access into a single complex product. This approach does not meet the unique needs of many people who would be better served with a more customized health care approach that is possible when these three elements are handled individually. Bundled payments provide a way to lower costs and improve quality of care for specialty services.

At the conclusion of the article, Dave recommends several steps forward for healthcare administrators and executives:

  • Follow Medicare’s lead and increase the adoption of specialty bundled payment programs into the commercial health insurance market.
  • Expand the number of specialists and health systems that can participate in a bundled payment contract.
  • Work collaboratively to introduce innovations in coverage.
  • Empower patients to make informed decisions.
  • Conduct a bundled payment readiness assessment.

Read the full article here:

Got a question about bundled payments? Ask us now.

The Top Pitfalls in Commercial ACO Shared-Risk Arrangements

A response from Archway Health Founder and CEO Dave Terry was recently published in the Thought Leader's Corner in the Accountable Care News newsletter. In this section, various healthcare industry experts were asked to answer the following question: "What are the top pitfalls in commercial ACO shared-risk arrangements?" Here is Dave's response:

Commercial ACOs face three significant challenges: multiple business models, new investments and cross-organizational buy-in.

The first issue is trying to operate in two opposing reimbursement systems. Almost every provider organization in the country generates most of its revenue through a fee-for-service model, with incentives that drive more utilization. Yet in the ACO model, incentives are the opposite: They drive value through reducing utilization and partnering with efficient, lower-priced providers.

It is hard for any organization to operate within opposing business models, particularly so for healthcare professionals who often feel morally obligated to treat every patient the same regardless of how their bill gets paid. In order to fully embrace an ACO model, providers need to have 40% to 50% of their revenue derived through risk models with an expectation that they will move toward more than 75% in the next few years.

A second issue is investing in the tools and infrastructure required to succeed within an ACO model. These include claims data analytics, care management teams, patient tracking tools, reinsurance products and sophisticated management teams.

A third issue is gaining buy-in from primary care and specialist physicians within a network. Succeeding within an ACO requires doctors to change the way they deliver care. These changes include physician staffing ratios, new referral partnerships, changes in clinical protocols, increased use of nurse practitioners and physician assistants, better patient communication, telehealth and new ways to use data.

Got a question about bundled payments? Ask us now.

3 Ways Bundled Payment Models Brought Hospital Cost Savings

Writer Vera Gruessner included two quotes from an interview with Dave Terry in an article recently published at The article, titled “3 Ways Bundled Payment Models Brought Hospital Cost Savings,” looks at case studies that show how these savings were achieved. Dave is quoted as an expert on bundled payment and explains how CMS has handled some of the initial challenges that were part of launching the BPCI program. Read the full article here.

Why Healthcare Bundled Payment Models May Expand in 2017

Archway Health Founder and CEO Dave Terry is quoted in a new article published in In the article by Vera Gruessner, titled "Why Healthcare Bundled Payment Models May Expand in 2017," Dave discusses CMS bundled payment models, prospective versus retrospective reconciliation, MACRA, and the future of bundled payments. For commercial payers looking to get started in bundled payments, he also offers this advice: “Start soon. It’s never too early to start.” Read the full article here:


Smart Strategy, IT Consultants Preparing Their MACRA Pitches

Archway Health CEO Dave Terry is quoted in an article recently published in Value-Based Payment News, a monthly newsletter for professionals in healthcare. The article, titled "Smart Strategy, IT Consultants Preparing Their MACRA Pitches," discusses some of the opportunities that will be available for information technology providers and strategic consultants under the Medicare Access and CHIP Reauthorization Act (MACRA). “In order to succeed, these physicians will need help building and managing effective bundled payment programs and other types of care and risk management initiatives,” Dave says, as part of his summary of how physicians and specialists can prepare to participate in the program.

Read the full article here: