- Describe your topic.
- What does the evidence show on the effects of bundled payment versus usual (predominantly fee-for-service) payment on health care spending and quality measures? Does the evidence show differences in the effects of bundled payment systems by key design features? Does the evidence show differences in the effects of bundled payment systems by key contextual factors?
- Describe why this topic is important.
- The focus of the nomination is on the use of payment models by health systems– what data show bundled payments work/don’t work. Health systems are interested in how to handle cross-overs between patients in Medicare bundled payment models, other Medicare incentive/penalty programs, and commercial bundled payment programs. Healthcare systems face many uncertainties regarding BPs to include: • Decisions on whether to participate in BPs • What factors are associated with successful BP models • Which disease specific models to implement, • How to define the bundle, • How to implement them, how to structure payments, • Which providers and institutions to include (i.e. single vs. multiple) • Whether payments should be retrospective or prospective • How to handle gain (risk) sharing (e.g. “upcoding” and “unbundling”) • The future of public BP models in the current administration This topic is important given the effect of bundled payment models compared to usual payment models (e.g. fee for service, capitation) in terms of cost and quality is not clear. There is variation in payment models (e.g. clinical conditions, financial and non-financial incentives, organizational, market and patient characteristics) and the optimal configuration is unknown. The number of clinical conditions covered and the increased penetration of bundled payments in health systems has increased over the last few years.
- Tell us why you are suggesting this topic.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- Health systems can use a new AHRQ systematic review to inform decisions about which bundled payments to implement, the features of the bundles to include and the process for how to implement them. Given the concerns with the cost and quality of healthcare, a review on this topic may be of value to other stakeholder groups such as healthcare payers as they decide what clinical conditions, providers and institutions to include in bundled payments. A systematic review will inform the following questions: • How do health systems decide which bundled payment package to implement? • What is process for a health system to implement a new bundled payment package?
- How will you or your group use the information from a new evidence report?
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- Health Management Academy is exclusively comprised of executive members from the country's largest integrated health systems Healthcare payers such as Aetna, United Health, Blue Cross/Blue Shield
- Information About You: (optional)
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- Provide a description of your role or perspective.
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- Please tell us how you heard about the Effective Health Care Program.
