In designing an episode-of-care model that eventually will result in a more full-scale, successful bundled payment program, organizations should choose a model that is well-known and predictable, while taking concerted steps to foster provider collaboration.
Good candidates for episodes of care involve conditions "that are subject to well-defined episodes, where the specialist's needs and needs for other facilities are
within a range of predictability," said Lutes.
In terms of engaging providers to participate in such models, Lutes said the best candidate episodes are going to be ones that foster provider cooperation and care path development.
The clinical view of these episodes of care has been that there should be an "ideal pathway around which consensus can easily be built among clinicians, and [that] these episodes can be modeled around best practices," Lutes said. Such episodes typically have been confined to conditions or care patterns where the initiation of the episode "is fairly obvious to everyone, such as a surgery
of one sort or another," he said.
At the same time, developers of episode-of-care models should be looking for episodes that have a fair amount of variation in their costs "so that the participants in the demo or contract have a real opportunity to address variation, both in cost and quality," Lutes recommended.