Bundled Payment Models for Actinic Keratosis Management

Abstract

IMPORTANCE Recent legislation encourages alternative payment models, such as bundled payments. There are no clear recommendations on bundled payment design, and research on bundled payments for dermatologic care is limited. OBJECTIVE To investigate several methods to develop bundled payment models for actinic keratosis (AK) management and the likely effect on the cost of AK management. DESIGN, SETTING, AND PARTICIPANTS Cohort cost identification study using claims from Highmark Insurance and the MarketScan Commercial Claims and Encounters databases. Patients with claims for AK during the study period, January 2010 to December 2012, were included (N = 118 129). Utilization measures, such as visits and procedures, and direct costs were calculated and 8 bundled payment models were developed. Indirect costs were not included. MAIN OUTCOMES AND MEASURES The actual health care costs and theoretical cost differences for the bundled payments. Costs are reported in 2012 US dollars and were adjusted for inflation. The proportion of patients and clinicians with annual AK claim costs less than or equal to the bundled payments were calculated. RESULTS Eight bundled payment models were developed and 2, based on the 75th percentile payment, did not result in theoretical savings for any of the patient samples

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Do Second-Time Users of Topical Imiquimod have a More Rapid Onset of Clinical Response?

“…With changing payment models and the potential for bundled reimbursement for clearance of AK, knowledge of which therapies achieve and sustain the highest degree of clearance may have financial implications in the future. 7 Limitations of the study include the small sample size and the single clinical setting, in addition to the fact that our observations spawned from a QI project. Moreover, only actinic keratoses were studied, and the selfreported nature of the primary outcomes is subject to recall bias.…”

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“…Although alternative payment methods are currently being used and developed throughout the US, such as bundled payment models for actinic keratosis management, working in a value-based manner remains relatively novel in the field of dermatology. 15,16 Determining which outcomes to measure is an important first step in the transition to a value-based approach. There are, however, several considerations that need to be taken into account.…”