8.Potential to Bring Different Payment Models to Work Together

MODULE 9 | Section 8 of 12

Potential to Bring Different Payment Models to Work Together

COMBINING REIMBURSEMENT MODELS

“Because Medicare and commercial payers are likely to continue using both bundled payments and global budgets, ensuring that bundles and ACO programs are integrated will be important for the next generation of bundled payment models. Early evidence suggests that bundled payments and ACOs can be complementary (eg, Medicare’s ACO programs have primarily experienced savings from reductions in acute hospital and outpatient physician payments, whereas its bundled programs realized savings in postacute care payments).

– Drs. Amol Navathe, Zirui Song, and Zeke Emanuel, 2017.1

 

 

This strategy is similar to what leaders from Dell Medical School, Drs. Bozic and McClellan, suggest with upstream bundled payments for conditions complementing population-based payment mechanisms.2

This could be similar to how we suggested in Module 4 that patient-centered medical homes and integrated practice units can collaborate and coordinate to provide whole-patient coordinated care and condition-specific expertise. To make this work on the payment side, it would be critical to align incentives and proactively share information on shared beneficiaries.1

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“The simplest approach is to count episodes for patients in ACOs in the bundle program by including the actual episode costs for assigned beneficiaries within the global costs of ACOs.”1
While there may still be many details to work out, these newer payment models shift health care away from the issues of the current FFS model toward one that more appropriately supports value for patients.

Learn More

ARTICLE

This article explores methods and implementation models for bundled-based payments and is am excellent primer for understanding practical applications.

Navathe AS, Song Z, Emanuel EJ. JAMA.

REFERENCES

  1. 1- Navathe AS, Song Z, Emanuel EJ. The next generation of episode-based paymentsJAMA. May 2017. doi:10.1001/jama.2017.5902


  2. 2-Andrawis JP, McClellan M, Bozic KJ. Bundled payments are moving upstream. NEJM Catalyst. In press.

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