Health Affairs article evaluates bundled payment pilot project

Posted on November 8, 2011 | No Comments
Filed under Health Care Quality and Delivery System Reform, Library, Third Party Resources

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The Affordable Care Act (ACA) introduced the bundled payment model, which provides payment for all of the care a patient needs over the course of a defined clinical episode. The goal of bundling payment is to encourage doctors, hospitals, and other health care providers to work together to better coordinate care for patients both when they are in the hospital and after they are discharged. An article recently released by Health Affairs evaluates the initial “road test” of the PROMETHEUS Payment, one of the bundled payment pilot projects. The pilots have taken longer to set up than expected, primarily due to the intricate payment model and the fact that it builds on the existing fee-for-service payment system. Although participants were hopeful regarding the success of the bundled payment program, the report found that desired benefits may take some time to materialize.

To read CMS’s Fact Sheet regarding Bundled Payments, click here.

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CMS releases details, RFA on bundled payment initiative

August 24, 2011

The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has formerly announced the Bundled Payments for Care Improvement initiative. This initiative, authorized by the Affordable Care Act (ACA), proposes that various provider reimbursements for multiple services a person may receive during the normal course of an illness or injury be bundled together into one payment. The initiative allows broad flexibility for providers to determine which services may be bundled, as well as what share of the single payment may be allocated to each provider. CMS intends for this initiative to improve care coordination and reduce costs in Medicare, and has issued a Request for Applications (RFA) from interested parties on the four (4) different proposed bundling models. For more information on bundled payments, click here.

Bundled Payments – Medicaid Demonstration Project

July 7, 2010

The health reform law requires the Secretary of HHS to establish a Medicaid demonstration project “to evaluate integrated care around a hospitalization.” Specifically, this project aims “to evaluate the use of bundled payments for the provision of integrated care for a Medicaid beneficiary . . . with respect to an episode of care that includes a hospitalization . . . and for concurrent physicians services provided during a hospitalization.”

Bundled Payments – Medicare Pilot Program

May 5, 2010

A Medicare pilot program will be set up under the new health reform law to test “bundled payments” for certain “applicable conditions” around a hospitalization.

Commonwealth issue brief addresses innovative payment approaches

June 30, 2010

The Center for Medicare and Medicaid Innovation, created by the Affordable Care Act (ACA), has a mandate to develop innovative payment models to improve health care delivery. The aim of this initiative is to achieve higher quality health care delivery and slower cost growth. The Commonwealth Fund Commission on a Higher Performance Health System's issue brief, "Developing Innovative Payment Approaches: Finding the Path to High Performance," discusses how the development, implementation, and evaluation of new care payment approaches can be improved, and how those improvements can help achieve the broader goals of health reform. The brief focuses largely on Medicare, but also considers how payment innovation pilots should not be limited to Medicare alone. Instead, payment innovations should also include Medicaid and the Children's Health Insurance Program (CHIP) to minimize the fragmented nature in which health care is provided.