Bundle Payment Program Initiative: Roles of a Nurse Navigator and Home Health Professionals

Area of Science:

• Healthcare Economics
• Health Services Research
• Value-Based Care Models

Background:

• The Affordable Care Act prompted the Centers for Medicare and Medicaid Services (CMS) to develop new payment models.
• Value-based care initiatives aim to align financial incentives with quality outcomes.
• The CMS Innovation Center was established to test innovative healthcare delivery and payment strategies.

Purpose of the Study:

• To implement and evaluate the Bundled Payment Care Initiative, a novel value-based payment model.
• To assess the potential of bundled payments to reduce Medicare expenditures.
• To determine if bundled payments could maintain or improve the quality of care for beneficiaries.

Main Methods:

• A hospital-based home care agency, Abington Jefferson Health Home Care Department, led the program's development and implementation.
• Hospitals were authorized to participate in a pilot program.
• The initiative focused on innovative service delivery across the care continuum.

Main Results:

• The Bundled Payment Care Initiative represents a creative approach to healthcare payment.
• The pilot tested a value-based care model within a hospital-based home care setting.
• Implementation focused on improving care coordination along the patient journey.

Conclusions:

• Bundled payment models offer a pathway to test value-based care strategies.
• Innovative approaches are crucial for managing healthcare costs and quality.
• The initiative demonstrated a method for improving care continuity and testing payment reform.