Payment reform means changing how we pay for care in order to improve the quality and affordability of care. “Bundled Payments” is one form of changing our reimbursement methods. A recent Division of Health Care Finance and Policy report (pdf) defined the term and explained why it’s important:
A bundled payment is a method of reimbursing a provider, or group of providers, for the provision of multiple health care services associated with a defined episode of care under a single fee or payment.1 Also referred to as an episode-based payment, a bundled payment can be structured to cover multiple providers in multiple settings.2 For example, a single payment would be made for a knee replacement surgery, including pre-admission testing, hospitalization, surgery, post-discharge rehabilitation, and follow-up care. One primary purpose of facilitating the adoption of the bundled payment methodology as a way of reimbursing providers is to stop paying multiple providers for piece work in caring for people. Care should be delivered by providers working together in teams to achieve specific outcomes for specific conditions. The bundled payment recognizes the team-based approach to encourage care coordination and eliminate the incentive under the fee-for-service system for providers to drive up volume without improving quality.
Today DHCFP hosted a successful and well-attended Bundled Payments Symposium, to look at how they can be implemented in Massachusetts.
Introductory remarks came from the Secretary of the EOHHS, Dr. JudyAnn Bigby, followed by the symposium objectives from David Morales, the Commissioner of the Division. Stacey Eccleston, the Assistant Commissioner for Health Research and Policy at the Division, provided a brief overview of bundle payments, followed by panel presentations. The panelists were Neil B. Minkoff, the Medical Director for 1776 Health Care, Rome Walker, the Regional Vice President of Wellpoint (Unicare), Timothy Ferris, the Medical Director of the Mass General Physicians Organization at the MGH, and three executives from the Baystate Health Group, Peter Straley, Evan Benjamin and Stephen Sweet. The moderator for the panel discussion was Philip Gaziano, President & CEO of Accountable Care Associates.
Experts discussed their experience with bundled payment methods with the intent to provide technical information to those wishing to consider the methodology. Panelists presented information on the design and implementation of current bundled payments systems and provided members of the provider, payer and consumer communities with the opportunity to share experiences with the system and finished off with an open discussion with the panelists. Information from the symposium will be incorporated into Volume Two of DHCFP’s published series of technical assistance reports. Volume One (pdf) was published last week.
The conversation was lively as the system is complex and there are many perspectives on preparing, implementing and evaluating bundled payment systems, especially when it comes to prospective versus retrospective methods. Two points were stressed for the audience to take home. The first was an emphasis that bundled payments are not the single solution to the spiraling health care costs. Some of the other factors the panelists proposed in addition to bundled payments included Medical Home models, disease prevention, transparency of quality information, and consumers education and engagement. The second point that was illustrated clearly was that achieving successful bundled payment systems will not be easy or quick. The panelists agreed that stakeholders must take quality, patient experience, integration and innovation into consideration with every step towards this transformation. But the experts also agreed that currently available data supports that in the long run, a transformation to bundled payments will be a primary tool in fixing the health care systems’ high costs and will increase quality of care for the patients.
-Courtney Mulroy
