Alternative Reimbursement Models: Bundled Payment and Beyond: AOA Critical Issues

Area of Science:

• Health Services Research
• Healthcare Policy
• Payment Reform

Background:

• The Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013.
• Established under the Patient Protection and Affordable Care Act (PPACA), BPCI aims to transform healthcare payment methodologies.
• The initiative explores episode-based payment models to improve care delivery and reduce healthcare costs.

Purpose of the Study:

• To evaluate the applicability of episode-based payment models within the BPCI initiative.
• To assess strategies for successful implementation of alternative payment models.
• To identify the roles of various healthcare stakeholders in achieving program goals.

Main Methods:

• Analysis of the four BPCI models, awardee types, and number of awardees.
• Examination of data from a BPCI-designated pilot site.
• Review of strategies for implementing alternative payment models.

Main Results:

• Evidence suggests that alternative payment models can be successfully implemented.
• Strategies exist to prioritize patients while improving care coordination, alignment, quality, and cost reduction.
• Provider engagement and adaptation are crucial for success.

Conclusions:

• The BPCI initiative demonstrates the potential of episode-based payments to transform healthcare delivery.
• Successful implementation hinges on provider willingness to embrace change and identify opportunities.
• Open dialogue between CMS and awardees is vital for program evolution and gainsharing opportunities.