An Empirical Framework for Breast Screening Bundled Payments.

Area of Science:

• Health economics
• Radiology
• Oncology

Background:

• Bundled payment models are increasingly adopted to control healthcare costs and enhance care quality.
• Current models primarily focus on treatment episodes and primary care, limiting broader participation.
• Medicare aims to transition from fee-for-service to alternative payment models, necessitating wider specialty involvement.

Purpose of the Study:

• To explore breast cancer screening episodes as an opportunity for bundled payment models.
• To develop and calibrate a bundled payment model for breast cancer screening.
• To provide a framework for other cancer screening bundles.

Main Methods:

• Developed a bundled payment model for breast cancer screening.
• Calibrated the model using national Medicare claims data and private health system data.
• Included alternative screening episode definitions, price calibration methods, and risk examination.

Main Results:

• Service utilization for breast cancer screening and diagnosis remained stable.
• Including high-risk patients did not significantly alter estimated bundle prices.
• Bundle prices demonstrated sensitivity to the selection of included services.

Conclusions:

• Breast cancer screening offers a pathway to expand bundled payments within radiology.
• The developed framework can be adapted for other episodic specialty bundles.
• Screening bundles, encompassing initial and follow-up imaging, may boost adherence to guidelines and improve public health.