Bundled and global payments for care encourage providers and other stakeholders to work together on innovative strategies that reduce system inefficiencies, improve the quality of care, share savings, and work towards full system care coordination.
A bundled payment is defined as a single payment to a provider, or a group of providers, for multiple health care services associated with a defined episode of care. Most episodes of care have a reasonably well-defined beginning and end, but for management of chronic conditions, episodes are defined as all the condition-related services in a certain period of time (e.g., twelve months).
A global payment is a fixed payment to providers for all or most of the care that their patients may require over a contract period, such as a month or a year, adjusted for severity of illness.
The major difference between global payment and bundled payment is that bundled payments cover the episodes of care for patients with certain conditions, while global payment covers total care regardless of how many services are provided to patients.
In CIVHC's Framework for Transforming the Health Care Payment System, bundled payments are a Midway Milepost (2015) stepping stone to achieving a global payment system environment in 2018. Based on a preliminary survey of commercial payers (late 2011), approximately 10% of care paid for by commercial payers is non-fee for service (bundled payments or global payments). CIVHC is working to engage payers in implementing bundled payments for the following specified chronic conditions and treatment episodes:
Bundled Payment Conditions and Procedures
|Coronary Artery Disease (CAD)
|Coronary Artery Bypass Graft (CABG)
||Low Back Surgery
Getting Started: Bundled Payment Resources