Look to the future of bundled payment programs
By Brian Eastwood
Reaping savings from true bundled payments depends on benefit design, quality of service and performance, says Andréa Caballero, program director for Catalyst for Payment Reform. If providers are expected to dramatically change the way they do business, they are going to expect to be rewarded with volume, she adds.
Success also requires baby steps. The University of Pittsburgh Medical Center uses what Thomas Aubel, director of medical payment strategy and policy, describes as a shared savings-bundled payment hybrid model that does not yet incorporate a measure of risk on the part of a provider.
Blue Cross and Blue Shield of North Carolina, for its part, has a stop-loss in all its contracts; if member costs exceed a certain limit, reimbursement reverts to fee for service, says Elaine Daniels, senior strategic contract consultant with BCBSNC.
To gain traction, bundled payments must move beyond traditional episodes of care and begin to cover chronic as well as acute conditions. This is starting to happen--UnitedHealth is bundling payments for the MD Anderson Cancer Center in Houston, while the Arkansas Health Care Payment Improvement Initiative is investigating bundled payments for upper respiratory infections, attention deficit hyperactivity disorder and perinatal care in addition to hip and knee replacements, according to Health Affairs.
Further progress will come from paying careful attention to quality care guidelines, as that information will help health plans ensure that bundled payment programs meet their goals.
Quality metrics should expand beyond claims data as well to include patient satisfaction and potentially avoidable complication rates.
"There's a very important quality piece that overrides all that we do," Aubel says.
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Look to the future of bundled payment programs
