As insurers launch various types of value-based contracts, including accountable care organizations, patient-centered medical homes and bundled payments, could they be paying shared savings for the same patient to more than one provider?
It's possible, for example, that insurers could be responsible for paying a specialist doctor participating in a bundled payment contract as well as the primary care physician who treated the same patient as part of an ACO or PCMH, reported AIS Health.
"The issue is, how many times can you share savings?" Steve Spaulding, senior vice president of enterprise networks at Arkansas Blue Cross Blue Shield, told AIS Health. "If an [obstetrician] is $200 less than the target on average, that OB gets $100 per episode. If the OB is doing that for the primary care physician as part of a medical home, then you can't also pay that primary care physician the $100--you'll wind up with a hole in your pocket."
Horizon Blue Cross Blue Shield of New Jersey offers bundled payments, PCMHs and ACOs to more than 500,000 members and often sees overlap in savings, including when a patient enrolled in an ACO receives a bundled knee replacement. "At this point, both parties share in savings," Lili Brillstein, Horizon's episode of care director, told AIS Health. But "we have to make sure we don't count those savings two times," she added.
That's why it's vital that insurers work out the details surrounding shared savings in their value-based contracts and consider incentivizing providers through nonfinancial means. Because one thing is for sure: Value-based payments are here to stay. Indeed, insurers, patients, providers and even employers all support the idea of bundled payments, FierceHealthPayer previously reported. What's more, ACOs have seen strong growth, covering more than 18 million consumers as of January.
To learn more:
- read the AIS Health article