Bundled payments need quality guidelines


More healthcare organizations are using bundled payments to lower costs, but they must supplement such arrangements with solid quality care guidelines.

That's why UPMC Health Plan in Pittsburgh has developed several parameters to judge the success of its pilot bundled payment program for hip and knee replacement surgeries that launched last year, reported the Pittsburgh Business Times.

The guidelines, which include patient satisfaction and the amount of blood needed during operations, have helped the program achieve promising results based on more than 1,000 hip and 1,800 knee replacement surgeries.

"It's been very rewarding for us and the health plan," Sandra McAnallen, UPMC's senior vice president of clinical and quality performance, told the Business Times. "We are seeing physicians totally engaged in this" plus she added that "patient satisfaction scores have been high."

UnitedHealth also has found success in using bundled payments, lowering medical costs for breast, colon and lung cancer treatment by 34 percent, according to a new study published in the Journal of Oncology Practice.

Along with five participating medical oncology groups, UnitedHealth established more than 60 quality and cost measures to determine whether the bundled payment program was achieving its goals. Those guidelines included the number of emergency room visits, complications and side effects.

"These new payment models benefit patients, doctors, payers and the entire health system, and are particularly important as the nation faces ever-increasing healthcare costs," Lee Newcomer, senior vice president of oncology at UnitedHealth, said yesterday in a statement.

To learn more:
- read the Pittsburgh Business Times article
- see the UnitedHealth statement and study

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