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Francois de Brantes

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Dearth of data on bundled payment effects

A Modern Healthcare news analysis finds a dearth of data on the effects of bundled-payment models on  costs and  healthcare quality, a challenge emphasized by the latest government report on Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) initiative.

“In one clinical episode—orthopedic surgery—setting a flat price for all of the care delivered during the episode of care appeared to reduce costs and improve patient outcomes. But for others, there simply wasn’t enough evidence to declare the bundle a success or failure,” the news service concluded.

“It’s hard to draw conclusions either way from this report,” said Dr. Chad Ellimoottil, an assistant professor at the University of Michigan whose research focuses on alternative payment models, including bundled payments.

“The results to me just reinforce what we already know,” said Francois de Brantes, executive director of the Health Care Incentives Improvement Institute, a not-for-profit organization that studies and promotes value-based payment models. “For some of these episodes, like joint replacement, it works fine,” he told Modern Healthcare. “Everything depends on the episode or the condition or the illness you’re looking at.”

Modern Healthcare said that Mr.  de Brantes “was less sanguine about the administration’s full-steam-ahead approach. He questioned several aspects of its bundle design, including that the episodes are triggered by hospitalization rather than encompassing the management of a condition. He also criticized the lack of adjustment for patient severity.”

“Could it be a lot more definitive and improved over time? Of course,” de Brantes said of Medicare’s bundled-payment models. “It’s up to the government to really come to grips with how to design this the right way and how to implement it the right way.”

But Mark Fendrick, a professor at the University of Michigan and director of its Center for Value-Based Insurance Design, said: “The BPCI evaluation adds to the growing body of research that changing provider incentives away from a volume-driven model can produce modest savings without compromising quality of care.”

To read the Modern Healthcare analysis, please hit this link.



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