Risk Protected Bundles

Risk Protected Bundles are prospective bundles that contain the cost of risk within the bundle price. BLISCare assumes the risk of all medical care related to the procedure that fall outside the planned event.

The Problem

Value-based payment is becoming increasingly more common in the commercial marketplace. Employers are contracting directly with providers, and health plans also are modifying their contracts to pay for outcomes, not simply services. In many circumstances, this is represented through a bundled payment where the provider assumes the risk of medical costs over a period of time associated with a procedure (Prospective Bundles).

Most physicians and facilities are not equipped to perform the actuarial analysis necessary to understand the frequency of complications during surgery and post surgery that can impact the total costs in an episode of care. Additionally, neither are they in a position to assume the uncertainty of when those complications occur and the negative financial impact that uncertainty can bring.

Our Solution

BLISCare allows providers to confidently create Risk-Protected Bundles. BLISCare quantifies the risk associated with the potential outcomes and assumes the financial responsibility for the additional medical bills associated with the negative outcomes. Providers can enter into those payment models knowing their downside risk is covered. The benefits of a risk-protected bundle are:

• Cost Certainty - fixes the cost of risk in the bundle

• Guaranteed Margin - no variability in the financial outcome of the bundle from one procedure to the next

• Performance Reward - risk fees are adjusted over time to accurately align with actual performance