Using health information technology to enhance care outcome accountability through bundled payments.

Abstract

INTRODUCTION/BACKGROUND: To revise the cost and quality imbalance in the current US healthcare system, new models have been recommended that will tie health care reimbursement with efficient outcomes. Bundles Payments for Care Improvement (BPCI) initiatives focus on measuring the degree of success in improving quality care and reducing cost with selected organizations (Centres for Medicare and Medicaid Services, 2016). In reviewing the several models suggested through the BPCI, the focus is to determine a retrospective bundles payment arrangement that will reconcile the actual rendered care services' cost with the targeted price for a given episode of care. METHOD: The mixed-method research method utilises a design science research methodology (DSRM). The study is based on categorizing medical procedures based on predetermined bundles payments. Further, it examines the role of the developed technology solution to assist with promoting accountability. The study focuses on enabling healthcare facilities to determine bundled payment encodings and reflects the codes in the payment process. Facilities will be capable in identifying the procedural charges of clinical processes according to bundle settings. RESULTS: This is a research in progress study. The main idea of this study is to assist healthcare facilities in creating road maps prior to adopting bundled payments. Currently, the conceptual model and first parts of the technology solution have been developed and we are confident at the conclusion of the project a fully operational solution will bring the desired outcomes as well as significantly contribution to theory. CONCLUSIONS: Replacing fee-for-service with pay-for performance (P4P) is aimed at rewarding healthcare facilities who provide higher quality of care with reduced cost. The main goals of P4P include ensuring that patients receive adequate, timely, cost-effective and efficient care through improving quality of care, reducing complication episodes, and emphasizing on timely and preventive services. This environment requires sophisticated technology solutions.