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Value of value-based care not yet clear


An article in NEJM Catalyst by three  Catalyst for Payment Reform officials finds sharp growth in valued-based medical payments — “about half of all commercial payments to doctors and hospitals now flow through value-oriented methods. However, none of these efforts have demonstrated conclusively that this increase in value-oriented payments has led to better, more affordable care.”

Take bundled payments. The three write:

“Results on bundled or episode-based payment models have been mixed.  {The Center for Medicare and Medicaid Innovation} Bundled Payments for Care Improvement (BPCI) initiatives have produced variable outcomes. However, other initiatives, such as the episode-based payment programs implemented by the Medicaid agencies in Arkansas and Tennessee, have had success in reducing unnecessary utilization and episode costs, as well as improving the quality of care for certain conditions. The Pennsylvania Employees Benefit Trust Fund, working with the Health Care Incentives Improvement Institute (HCI) in a pilot program for total hip and knee replacements, demonstrated decreases in outpatient costs by $3,524 on average, and UnitedHealthcare’s oncology model led to a reduction of cancer episode costs for five medical groups by a combined $33 million.”

The trio go on:

{THE} “transition from fee-for-service accomplishes nothing unless these reforms are working and balance the significant investments that providers, health plans, and purchasers are making to support these changes — investments such as integrated electronic health records or new staff for care support teams. Even patients may feel frustrated if these changes put barriers between patients and their providers or in any way disrupt the doctor-patient relationship.”

To read the NEJM piece, please hit this link.


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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