Developing a Prospective Payment System Based on Episodes of Care

Averill, Robin; Goldfield, Norbert; Hughes, John S.; Eisenhandler, Jon; Vertrees, James C.

doi:10.1097/jac.0b013e3181ac9d6f

Cited by 11 publications

(13 citation statements)

References 3 publications

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“…Nonetheless, if bundled payment contracts are well designed, they may not need to be mandatory. Several researchers believe that most providers will voluntarily sign a contract that rewards them for providing higher‐quality care at a lower cost as long as they are held accountable for only the performance risk (which they can control) and not the insurance risk (which they cannot control) . This important precondition also applies to a second element in this phase, regarding the barriers that can be caused by “small and heterogeneous patient populations” (element 11).…”

Section: Resultsmentioning

confidence: 99%

Unraveling the Complexity in the Design and Implementation of Bundled Payments: A Scoping Review of Key Elements From a Payer's Perspective

et al. 2020

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Because bundled payments are relatively new and require a different type of collaboration among payers, providers, and other actors, their design and implementation process is complex. By sorting the 53 key elements that contribute to this complexity into specific pre‐ and postcontractual phases as well as the actors involved in the health system, this framework provides a comprehensive overview of this complexity from a payer's perspective. Strategically, the design and implementation of bundled payments should not be approached by payers as merely the introduction of a new contracting model, but as part of a broader transformation into a more sustainable, value‐based health care system. Context Traditional fee‐for‐service (FFS) payment models in health care stimulate volume‐driven care rather than value‐driven care. To address this issue, increasing numbers of payers are adopting contracts based on bundled payments. Because their design and implementation are complex, understanding the elements that contribute to this complexity from a payer's perspective might facilitate their adoption. Consequently, the objective of our study was to identify and structure the key elements in the design and implementation of bundled payment contracts. Methods Two of us independently and systematically examined the literature to identify all the elements considered relevant to our objective. We then developed a framework in which these elements were arranged according to the specific phases of a care procurement process and actors’ interactions at various levels of the health system. Findings The final study sample consisted of 147 articles in which we identified the 53 elements included in the framework. These elements were found in all phases of the pre‐ and postcontractual procurement process and involved actors at different levels of the health care system. Examples of elements that were cited frequently and are typical of bundled payment procurement, as opposed to FFS procurement, are (1) specification of care services, patients’ characteristics, and corresponding costs, (2) small and heterogeneous patient populations, (3) allocation of payment and savings/losses among providers, (4) identification of patients in the bundle, (5) alignment of the existing care delivery model with the new payment model, and (6) limited effects on quality and costs in the first pilots and demonstrations. Conclusions Compared with traditional FFS payment models, bundled payment contracts tend to introduce an alternative set of (financial) incentives, touch on almost all aspects of governance within organizations, and demand a different type of collaboration among organizations. Accordingly, payers should not strategically approach their design and implementation as merely the adoption of a new contracting model, but rather as part of a broader transformation toward a more sustainable value‐based health care system, based less on short‐term transactional negotiations and more on long‐term collaborative relationships between payers and provide...

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Section: Resultsmentioning

confidence: 99%

Unraveling the Complexity in the Design and Implementation of Bundled Payments: A Scoping Review of Key Elements From a Payer's Perspective

et al. 2020

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“…Het huidige systeem van inkopen, declareren en vergoeden van zorg gaat uit van de verrichtingen zoals die zijn vastgesteld door de Nederlandse Zorgautoriteit (NZa). 1 De NZa omschrijft welk soort zorg een zorgaanbieder mag declareren en aan welke voorwaarden de zorg moet voldoen. Voorbeelden zijn: een zitting fysiotherapie, een diagnostisch onderzoek of een behandeling in een ziekenhuis als een heupvervanging.…”

Section: De Huidige Manier Van Inkopen Stimuleert Volume Van Zorgunclassified

Ontwikkelingen in zorginkoop: van inkoop van verrichtingen naar inkoop van zorgbundels

Hijden¹,

Steenhuis²,

Hofstra³

et al. 2019

MAB

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Zorgverzekeraars en zorgaanbieders maken meestal contractafspraken op basis van een vergoeding per verrichting. Dat stimuleert echter volume van zorg in plaats van uitkomsten. Daarom passen zorgverzekeraars en zorgaanbieders steeds vaker ‘bundelinkoop’ als bekostiging toe. Dan wordt een bedrag per patiënt afgesproken. We beschrijven wat bundelinkoop is en introduceren de contractelementen. De impact van zorgbundels is dat ze door een andere verdeling van (financiële) verantwoordelijkheden uitkomsten centraal stellen, schotten doorbreken en innovatie stimuleren. Opschalen van deze methode van zorginkoop vraagt om standaardisatie van de contractelementen en uniformiteit van de bundeldefinitie per aandoening anders nemen de administratieve lasten voor zorgaanbieders toe.

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“…However, during the post-acute care period, the patient's chronic illness burden is likely to be one of the primary determinants of resource use rather than the acute illnesses that precipitated the hospitalization. It is reasonable to hypothesize that the impact of the patient's chronic illness burden will increase, and the impact of patient acuity as measured by MS-DRGs will decrease, as the post-acute care period is lengthened (Averill, Goldfield, Hughes, Eisenhandler, & Vertrees, 2009). In order to test this hypothesis, a measure of patient chronic illness burden was needed.…”

Section: Unit Of Paymentmentioning

confidence: 99%