3 key elements for the next generation of bundled payments

Though the future of the Centers for Medicare & Medicaid Services’ bundled payments is up in the air, the program’s next generation should take three steps to better align with population health goals.

Bundled payments, at present, have limitations, according to an article written by experts at the University of Pennsylvania for the Journal of the American Medical Association. The program, at present, includes many of the same incentives as fee-for-service payments, encouraging doctors to do more, especially for patients with conditions that may not have clearly defined interventions, and to recruit healthier patients.

“Innovations in bundled payment design could increase their attractiveness to commercial and public payers alike in the pursuit of higher-value care,” the authors, led by Ezekiel Emanuel, M.D., professor of medical ethics and health policy at Penn’s medical school, wrote.

But if the next generation includes three key elements, it will better accomplish population health goals, according to the article:

  1. Extend the duration of bundles. At present, bundles are short, with most covering only 90 days of care after discharge. Extending the length to a year or longer would allow for the expansion of bundled payments to more conditions and also include longitudinal care. For example, maternity bundled payments could cover prenatal, delivery and neonatal care.
  2. Move outside of hospitals. Medicare accountable care organizations have succeeded in cutting costs largely because they’ve reduced unneeded hospitalizations. Bundled payment programs should also align with this goal, according to the article. One way could be to allow outpatient clinics to take on some of the financial accountability for performance measures.
  3. Integrate bundled payments with ACOs. Because these payment models have separate goals, early evidence suggests they can align well. This would require a change in policy, however, as CMS’ current rules for the bundled payment programs would require adjustments to make integration work.

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CMS has delayed the start of new bundled payment programs and the expansion of others to January, a move that raises questions about the Trump administration’s long-term commitment to the programs. Department of Health and Human Services Secretary Tom Price is not a backer of bundled payments, saying that the programs overstep CMS’ bounds.