Healthcare Providers

Payment Transformation

Medicare, Medicaid and commercial payers are all looking for new ways to pay providers.  “Pay for value” and “Pay for performance” are replacing the traditional fee for service approach.   We have the data, tools and expertise to help the industry move towards value based payment.

Navigant is an industry leader in designing and implementing payment systems for many of the largest payers and providers in the industry including state Medicaid plans, a select number of commercial plans and many of the nation’s top providers.   Our large databases, tools, strategic insights and expertise in rate setting distinguish us from competitors.

  • Fee For Service Plus Pay for Performance/Bonus Payment Solutions:  We have assisted several large payers and providers design and implement pay for performance programs to supplement traditional hospital, physician and ancillary fee schedules.  Our work includes rate benchmarking relative to cost, Medicare and market – as well as specialty-specific performance payments that we design in partnership with physicians and hospitals.
  • Episodic Bundling Solutions:  We have worked with a variety of payers and providers to design and implement  bundled payments for episodes of care.  Examples include money back guarantees for various services, as well as 30 day readmission bundles for major payers/providers.  The work includes considerable analysis of resource utilization and cost patterns in partnership with clinicians, and the creation of a severity-adjusted payment per patient and health event (e.g., hip fracture or knee replacement).
  • Severity-Based Grouper Solutions:  We work with payers and providers to implement a variety of severity based grouper solutions for inpatient and outpatients services.  Systems include the 3M® APR-DRG and EAPG groupers and related packages to identify and measure preventable readmissions, complications and events.
  • Global Bundling/Capitated Risk Solutions:  We work with payers and providers to design and implement capitated solutions for particular populations, services, etc.
Click here to read our white paper on Global and Episodic Bundling: An Overview and Considerations for Medicaid.


BCBS Organization Value Based Payment Design – Total Cost of Care Solution
Navigant assisted a large plan with the refinement and negotiation of a per-patient global budget with significant performance incentives based on efficiency and quality measures from its HMO product.  The health plan wound up offering differing levels of risk sharing arrangements with provider organizations, depending on the size of the group, the degree of integration, and the ability to assume risk for utilization and variations in care.  


BCBS Organization 30 Day Readmission Bundle
Navigant assisted a major organization with the analysis and design of 30 day readmission bundle for all inpatient services.  Other examples include medical home bundling and various pay for performance approaches for other payers and providers.

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