Episodes of Care

Episodes of Care Initiative

Overview

As a key value-based care strategy, bundled payments are an alternative payment model that offers incentives to providers to increase coordination and efficiency of care while improving quality and outcomes at lower costs. The National Alliance is collaborating with Remedy Partners, the nation’s leading episodes of care company, to help accelerate development of employer adoption of bundled payments across the country.

Our Path Forward

National Alliance member coalitions will continue to assist purchasers in the development, implementation and administration of bundled payment programs with multiple employers active in Florida through the Florida Alliance for Healthcare Value. Other states such as Colorado, Pennsylvania, Tennessee and Texas are also moving forward. To support these efforts, a toolkit is being developed that will provide materials to support the implementation process and educate on standards and carrier assessments. 

For more information, please contact Karlene Lucas from the National Alliance of Healthcare Purchaser Coalitions, or Essie Quakyi from the Remedy Partners.

Frequently Asked Questions

What are Episodes of Care?

An Episode of Care is defined as the set of services provided to treat a clinical condition or procedure. It is bounded in time – for example, a year of treatment for a cardiac condition or 90 days for a major surgical procedure – and creates accountability for the management of the person’s condition or health event.

Why are Episodes of Care a top priority for the National Alliance and Coalitions?

The National Alliance and its member coalitions believe that as an alternative payment model, Episodes of Care hold the potential to greatly improve the value of care by holding providers accountable for episode-specific quality and costs. This means that through Episodes of Care employers have an opportunity to realize cost savings while significantly improving the quality of care their employees receive.

What is the overall objective for the Episode of Care initiative of the National Alliance, Member Coalitions, and their employer members?

The National Alliance and member coalitions partnership is intended to drive better outcomes through a reformation of the delivery system – powered by stronger incentives encapsulated in an Episode of Care program that empowers front line clinicians with the information they need to continuously improve quality and reduce costs.

What is the process for meeting the Episode of Care Initiative objective?

The National Alliance intends to meet its objectives for the episode of care initiative through a coordinated effort from multiple players, across markets. Specifically, the National Alliance will work with its Coalitions to empower employers to develop the national standards for building a successful episode of care program across the nation. The standards will be met by building collaboration with carriers and providers to understand their current capabilities. If needed, Remedy will bridge program-related gaps existing carriers may have in order to create a program that meets the Alliance/Coalition’s standards on a national scale. Remedy will provide the resources needed in order for providers to successfully participate.




Guiding Principals 


  • Common episode definitions -

    Enhances the meaningfulness of future quality measures and data

  • Quality & appropriateness of care - 

  • Double-sided risk alignment - 

    Catalyzes incentive alignment for providers, promoting success

  • Warrantied performance -

    Evolves toward a more rationale pricing structure, with narrower variance and integrates into other value-based payment programs. 

  • Relevance for Purchasers & Providers - Driven by quality, cost effectiveness and member selection, with other Episode of Care participation limitations being minimal

“Employer-led episodes of care can truly bring about the change required in the broken healthcare market. Working through our regional and national network of member coalitions can enable faster and more seamless execution of episode-of-care payment models across the country."

Michael Thompson, President & CEO, National Alliance