Health system pilots see lackluster bundled payment results

Bundling payments to providers for certain episodes of care may not yield savings and efficiencies as easily as once thought, according to a new study of the Prometheus payment project by the RAND Corp. and researchers at the Harvard School of Public Health. The three participating healthcare systems showed spinning wheels more than plan implementations.

Prometheus is a pilot project of the Health Care Incentives Improvement Institute. The participants are Crozer Keystone Health System-Independence Blue Cross in Pennsylvania, Employers Coalition on Health in Illinois, and Priority Health/Spectrum Health in Michigan.

But after three years of efforts, not a single bundled payment had been made, or a contract even entered into. All three projects lagged "months or years behind their planned milestones," said the study published in the most recent edition of Health Affairs, notes the Wall Street Journal blog.

The primary culprits were determining payment rates--a process hobbled by issues analyzing claims databases--and getting those rates to interface with the insurers' claims processing systems.

However, researchers have suggested that the efforts have helped better coordinate care at all three systems, and that advances in technology could make future bundling efforts progress more smoothly.

"The caution is that it's taken three years and it's not clear that it's going to work, but even after struggling for three years ... they're still sticking with it and haven't walked away," Peter Hussey, a RAND researcher who led the study, told the WSJ.

For more information:
- read the Wall Street Journal blog post
- here's the Health Affairs abstract
- read the RAND press release