platform_og_phone_full-file-_-alllll-03Bundles Modeling & Administration

Cedar Gate is uniquely suited to serve as a shared point of contact and communication among healthcare organizations with 30+ years in bundled payment arrangements. Our platform identifies and develops bundle opportunities to reduce spend and improve quality of care.

Whether you’d prefer a complete, end-to-end outsourced solution or would rather choose from a variety of services to complement your current capabilities, we can help.

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The Bundles Process Has Never Been Easier

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Target Population

Use our proprietary platform to ingest your data and easily create customized bundle definitions that will then model a baseline episode experience. During this process our experts conduct an opportunity analysis to prioritize contracting for high-performers and calculate pricing while identifying potential quality targets. 

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Activate Market

During this phase we work with your organization to align a robust provider network, configure contract terms by line of business and episode, and develop provider-facing documents and baseline reports. Education will be top of mind for implementation and we have all the tools to make this a seamless process. 

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Administer Effectively

Our proprietary claims engine consolidates fees into a single bundled claim, then automatically unbundles and distributes payments to providers downstream while managing the risk pool. We also offer services including provider credentialing, network development, provider engagement, payer/provider contracting, patient experience and engagement, and bundled program marketing and expansion.

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Monitor and Optimize Performance

Monitoring each bundle program and optimizing it for sustainable performance using actionable analytics is key. We refresh data feed quarterly and perform a extensive analysis to determine ROI and progress. Employer and provider self-service portals with customizable reporting allow drill-down performance detail. 

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Achieve CMS Goals

Cedar Gate models all 32 BPCI-A bundles and utilizes CMS claims data attributed to our clients to analyze and determine which bundles have the best opportunities, relative to the CMS targets, which providers in our client’s system can best hit those targets, and perform review and reconciliation of financial performance across CMS programs.

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Actionable Insights & Workflows

Effectively create predefined and custom workflows or “plays” to drive improvements in financial, operational, and clinical performance. Use your pricing, claims, and utilization data to reveal the projected value and potential timetable of a play before you begin. Once you execute a play, then monitor, track, and display performance data, while receiving updated action items to improve performance throughout the year—not just at year-end. 

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Centers of Excellence (COE) Programs

Workforce expectations are on a collision course with economic reality as cost-sharing increases have outpaced employees’ abilities to pay. In order to recruit and retain talent, employers must provide employees with access to excellent care while also managing the cost of providing that care.

Cedar Gate offers an end-to-end solution for Center of Excellence programs that are designed for specialized care and treatment services. When the program is paired with prospective bundles, it allows a single payment to be disbursed to all providers involved. Depending on your specific benefits plan structure, our staff can help determine the best administrative route and provide technology to handle direct-to-employer invoicing or payer involvement.

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Win-Win Solution for All

Using our prioritization model, we configure and select a diversified blend of inpatient, outpatient, and/or blended care settings bundles along care pathways to mitigate program downside risk and increase the program size and market share. Our process ensures that we create win-win solutions for all participating parties, which is key to developing sustainable Centers of Excellence programs.

Employer

  • Boosts morale with high quality benefit program
  • Increases efficiency and performance with focus on prevention and coordinated care
  • Incentivizes appropriate care
  • Earns patient loyalty
  • Increases market share
  • Demonstrates value with increased predictability
  • Promotes mediation with self-insured employer clients
  • Experiences integrated care
  • Receives minimal financial burden
  • Access to world-class providers
  • Promotes quality of life outcomes

CENTER OF EXCELLENCE EXPANSION SERVICES

We know the importance of messaging when launching a Center of Excellence Program. To gain buy-in, the value proposition needs to be clearly communicated to all audiences involved. We are there to support you every step of the way to ensure your success and continuous growth.

Strategy

  • Define employer/payer/health system approach based on initial bundle offering
  • Create and execute a public communications plan
  • One-page promotional slicks
  • Press Releases and publicity
  • Website & health fair messaging
  • Participate in payer/broker meetings to support knowledge transfer
  • Employer/Payer pitch decks
  • Support onboarding and program navigation
  • Provide integrated communication strategy
  • Supply education resources with targeted follow-up

Serving

payers

Payers

Manage risk more effectively and obtain greater value for every healthcare dollar.

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providers

Providers

Act on emerging opportunities to transform operations and improve financial performance.

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employers

Employers / ASOs

Recognize high-value innovation opportunities in healthcare with our help.

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Discover More

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Case Study

A Large Employer’s Center of Excellence Program Delivers 20 Years of Successful Outcomes

As one of the largest employers in Texas, this company pledged to change the experience for employees…

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Value Viewpoint

Pandemic Sparks Payment Model Reform

Transitioning fee-for-service healthcare to value-based care models has not been easy…

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White Paper
White Paper

Successful Bundle Payment Programs Unite Payers and Provider

The traditional fee-for-service reimbursement model has caused a deep-seated mentality…

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SOLUTIONS

Cedar Gate’s enterprise performance management analytics and administration platforms reduce risk, enhance financial performance, and improve patient outcomes for healthcare organizations across the value-based care continuum.

Enterprise Data Management

Capture, organize, and utilize all valuable data sets securely and easily.

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Empower your team with timely information to take action and reach performance goals.

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Transform the way you report on your business with these intelligent tool sets.

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Support medical management activities across the care continuum.

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Manage patients effectively from chronic conditions to transitions of care.

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Operate multiple lines of business with claims and benefits administration, eligibility, capitation reconciliation, financial management and more.

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Extend your effectiveness with managed, professional, or advisory services.

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