Perspectives on Advancing Bundled Payment in Ontario's Home Care System and Beyond

Now more than ever, healthcare funders are weighing options to drive better value in care delivery, including using bundled payments to compensate healthcare providers based on expected costs to achieve specific health outcomes for patients. Ontario is currently exploring options for expanding bundled payment beyond acute care to home care, primary care, long-term care and across the continuum of care. This paper reviews the evidence, including the Ontario experience with bundled payment, and identifies opportunities for advancing bundled payment in home care as well as with other sectors. The authors consider the most promising opportunities, offer perspectives on where to start and identify the critical success factors. They conclude that is unlikely that payment reform on its own would be sufficient to drive changes in care delivery across providers. Instead, the evidence from the review points to the need to shift the conversation on bundled payment to a larger strategy for integration of care across providers and to engage providers in designing solutions, particularly for supporting chronic and complex patients who require support from multiple providers across the system.