Bundled payments — and the general shift from fee-for-service reimbursement to value-based payment — have been in full swing for several guinea pig hospitals, health systems and payers over the past year. Along the way, many positive developments and challenges have also appeared with the capitated payment mechanism.
The Health Care Incentives Improvement Institute and Bailit Health Purchasing have published a new study that looked at 19 bundled payment initiatives across the country and how they evolved from May 2012 to May 2013.
The 19 provider-payer demonstrations involved nonfederal bundled payments, though the report said the findings could help those that plan on participating in CMS' Bundled Payments for Care Improvement program, which will start this fall. Some of the participants in the study included Anthem Blue Cross and Blue Shield of Missouri, Geisinger Health System in Danville, Pa., and the Vermont Green Mountain Care Board.
Here are some of the major takeaways from HCI3 and Bailit Health Purchasing's study:
• Of the original 19 bundled payment projects, nine are fully operational and plan to expand bundled payments to other services.
• Five provider-payer groups that had planned to do bundled payments in May 2012 either discontinued the demo or never started.
• The remaining five initiatives are either observing other bundled payment pilots or are still developing their own bundled payment program.
• The most commonly bundled conditions in the non-Medicare market were inpatient and outpatient procedural conditions, such as hip and knee replacements.
• The biggest challenges cited by both provider and payer groups included a lack of data, a lack of engaged leadership, not enough resources to try alternative payment methodologies and tepid local engagement by national health plans.
More Articles on Bundled Payments:
4 Steps Hospitals Can Take to Pilot Bundled Payments
6 Value-Based Credit Rating Metrics Hospital CFOs Need to Know
4 Considerations for Hospital Bundled Payment Programs