So far, the recent failure of a high-profile bundled payment pilot in California has not slowed enthusiasm for the concept from CMS.
In August, the RAND Corporation reported that a second major pilot study of bundled payments had failed. The news sent healthcare reform advocates looking for answers and brought out the critics.
A recent critique, appearing online in Forbes, called bundled payments “price controls by another name” and pointed out potential problems with the concept: incentives to skimp on care, or, conversely, “upcoding” to get more from Medicare if a patient’s condition is marginal or uncertain.
However, as The American Journal of Managed Care reported in July, CMS wants to expand its bundled payment program and anticipated an uptick in the number of healthcare organizations taking part. So far, there appears to be no backtracking from CMS on bundled payments, which are seen as a way to bring savings to government-funded healthcare.
What accounts for the disconnect? Some labeled the particular features of the failed pilot in California, administered by Integrated Healthcare Associates, as “no risk, no reward,” and others pointed to the uniquely difficult features of the state’s regulatory environment. Uncertainty clearly seemed to be a factor in provider dropouts, with hospitals saying they were unwilling to make the administrative or technical investment needed if there was no guarantee of a return.
Both the RAND authors and some of their critics observed that success can come from failure. For example, one commentator observed that payments should start in a retrospective model, then move to a prospective model.
As Jan E. Berger, MD, MJ, wrote in The American Journal of Pharmacy Benefits in June, “We are in a sort of ‘experimental phase’ with many of these new models, and we will not have all the answers from the start.
“What we do need to have is inquisitiveness, transparency, and the willingness to work together to address these issues openly in a way that leads us over time to the best method of meeting the goals of a bundled-payment model.”
Around the Web
Bundled Payment: Learning From Our Failures
The Bungling of Bundled Payments
AJMC: More Providers Opt for Bundled Payments
A Bundle of Joy: How Does the Trend of Bundled Payment Affect the Pharmacy Benefit?
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
Commonwealth Fund Report Details Pervasive Racial and Ethnic Disparities in US Health Care, Outcomes
April 18th 2024Using 25 health system performance indicators, the Commonwealth Fund 2024 State Health Disparities Report evaluated racial and ethnic disparities in health care and health outcomes both within and across US states and highlighted the urgent need for equitable health care policies and practices in the US.
Read More
Exploring Medicare Advantage Prior Authorization Variations
March 26th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.
Listen