Legal Issues in Designing Bundled Payments and Shared Savings Arrangements in the Commercial Payor Context

A promising method for restructuring the health care payment system involves packaging payments for multiple, related services into a “bundle” to pay for a single episode of care. For example, a bundled payment for a hip replacement surgery would include all services from the pre-surgical workup, to the actual procedure, and through rehabilitation. However, despite the fact that the Medicare program and commercial payors are embracing bundled payments as a way to reduce costs, many federal and state health care laws make bundled payments difficult to structure and implement.

While there has been some guidance on the requirements for Medicare bundled payments, there appears to be little support for facilitating and structuring contracts for bundled payments with commercial payors. This resource provides guidance and templates to help organizations work with commercial payors to develop successful and compliant bundled payment and shared savings arrangements.

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