News

CONTROLLING HEALTHCARE SPENDING THROUGH BUNDLED PAYMENTS

Washington, DC, November 21, 2017—Altarum and Payer Compass announce the combining of Altarum’s PROMETHEUS Analytics®, the model for all bundled payment programs implemented in the United States, and Payer Compass’s proprietary claim pricing technology, VisMed, to deliver a true, complete cost for healthcare procedures. This novel development leads the way as the next step in Reference-Based Pricing.

Bundled Payments reward value and reduce complications and duplicated services for treatment. The self-insured and plan members will save money, and equally as important, gain plan confidence, resulting in improved overall health.

This expansion builds on the platforms of VisMed and PROMETHEUS Bundled Pay™, pioneered more than 10 years ago, creating a unique model that benefits all parties: providers and facilities, the self-insured, and plan members. PROMETHEUS Bundled Pay™ aggregates services performed by individual providers within a member’s comprehensive treatment plan into one episode of care. Providing a Software as a Service (SaaS) system that monitors and applies multiple regulatory and CMS sources, VisMed works in tandem with PROMETHEUS’ treatment bundles, resulting in greater pricing accuracy.

The end result is one bill. Bundling all of the charges across one’s care—hospital, physician, laboratory, pharmacy, rehabilitation facility, etc. creates more efficient, organized billing for plan members and allows them to get the right medical care at a fair cost.

The product will continue to add to its more than 90 different Episodes of Care priced as bundled payments for treatment categories such as cancer, behavioral health, cardiac/vascular health, men’s health, women’s health, GI conditions/procedures, maternity, orthopedic, neurosurgery, ophthalmology, endocrine, ENT, pulmonary issues, and more.

As payers, providers, policymakers, and consumers struggle with how to make healthcare more affordable, it’s essential to have the pricing and analytic tools that will provide the solutions with the greatest impact, and that’s what Payer Compass and Altarum are offering with the new Bundled Payments Program. Honed and perfected individually for more than ten years, these solutions are now combined and available to solve many of the challenges faced by payers and providers as reference-based pricing and value-based care become the realities of healthcare.

Payer Compass provides healthcare reimbursement services with best-of-breed technology. Our team is making a difference in healthcare with progressive claim pricing and editing technology, yielding savings of 30–40% over networks. Payer Compass’s solutions extend beyond pricing and include plan analytics, consulting and Reference-Based Pricing program that incorporates our claim pricing and editing technologies, along with care management, patient advocacy and balance billing support. We serve the self-insured and a variety of health plans (government, indigent care and Indian health services tribal plans). Our services are backed with a team of healthcare and reimbursement experts driven by a passion for technology and a standard of excellence.

Altarum is a national nonprofit whose mission is to create a better, more sustainable future through ideas and action that transform American health and healthcare. Since 2007, PROMETHEUS’ open access episode definitions have been used widely for public reporting. PROMETHEUS Analytics power the price and quality transparency resources for the states of Maryland, Colorado, and New York. Large health plans, including Anthem and Cigna, are using the PROMETHEUS Analytics to drive their value-based payment programs. And now, the unique healthcare insights and answers powered by PROMETHEUS are wider in scope, easier to use, and more innovative than ever.

If you would like more information about this healthcare initiative, please contact Ginger Barrientez, Director of Marketing at 469.215.2654 or email at gbarrientez@payercompass.com OR William Hicks, Business Development Specialist at 678.921.9223 or email at william.hicks@altarum.org