3 bundled payment lessons from the Netherlands

By Matt Kuhrt

The movement toward value-based payment models has spurred experimentation with bundled payments, but one researcher believes the U.S. could learn a lot about successful models from the Dutch, according to a NEJM Catalyst blog post.

Where U.S. bundled-payment efforts to date have focused on improving care in the hospital setting, namely through a CMS joint replacement initiative, Jeroen N. Struijs, Ph.D., senior researcher at the National Institute of Public Health and the Environment in the Netherlands, has been tracking a similar program targeted at improving primary care for patients with type 2 diabetes. Under the Dutch model, a clinical care group receives payment from an insurer for a year's worth of services.

Struijs sees potential lessons from both the successes and ongoing challenges raised by the Dutch experience:

  • The model's success stemmed from specific requirements regarding standard of care and criteria by which to measure improvements, but Struijs notes that, over time, quality measures will need to focus more on patient outcomes than the "process metrics" used in the diabetes program.
  • By involving primary care physicians, Struijs says the Dutch model's reliance on providers' clinical expertise reduced unnecessary tests and procedures overall. Unless the bundled payment eventually extends to specialists and hospitals, however, Struijs notes a potential incentive for primary care physicians to send patients requiring more complex care to specialists.
  • Getting providers to assume financial risk remains a struggle in the U.S., and despite the success the Dutch had in getting primary care groups to shoulder the load, Struijs suggests "more-disruptive payment models that focus on caring for patients rather than merely treating disease" will be necessary down the road.

To learn more:
- see the NEJM Catalyst article