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Designing a commercial bundle for cardiac procedures: The Percutaneous Coronary Intervention Episode Payment Model
John W Urwin1, Robert Bauer2, Jonathan Cunningham2
1Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, , USA.
Insights
Hawaii Medical Service Association developed a novel bundled payment for percutaneous coronary interventions (PCI EPM). This commercial model aims to improve cardiac intervention payments, unlike previous unsuccessful attempts in commercially insured populations.
Area of Science:
- Health economics
- Interventional cardiology
- Healthcare policy
Background:
- Cardiac interventions represent a substantial healthcare cost.
- Previous bundled payment models have failed in commercially insured populations.
- A novel commercial bundled payment, the Percutaneous Coronary Intervention Episode Payment Model (PCI EPM), was developed with HMSA in 2018.
Purpose of the Study:
- To describe the design and features of the HMSA PCI EPM.
- To compare the PCI EPM with existing Medicare bundled payment programs.
- To provide insights for designing future cardiac intervention payment policies.
Main Methods:
- Descriptive analysis of the PCI EPM's components: inclusion criteria, bundle contents, pricing, savings model, and quality metrics.
- Comparative analysis against Medicare's Bundled Payment for Care Improvement and Cardiac Care Model.
Main Results:
- The PCI EPM is the first commercial bundled payment specifically for percutaneous coronary interventions.
- It incorporates site neutrality and encourages outpatient care when appropriate.
- It features first-dollar shared savings and fewer incentivized quality metrics compared to non-commercial models.
Conclusions:
- The PCI EPM offers a unique approach to commercial bundled payments for cardiac procedures.
- This model's features may guide future health plans and policymakers.
- Exploring commercial bundled payments for interventional cardiology is promising.
Background:
Cardiac interventions account for a significant share of overall healthcare spending and have been the focus of several large-scale interventions to develop effective bundled payments. To date, however, none have proven successful in commercially insured populations. In 2018, we worked with Hawaii Medical Service Association (HMSA), the Blue Cross Blue Shield of Hawaii, to design a novel commercial bundled payment for percutaneous coronary interventions, the Percutaneous Coronary Intervention Episode Payment Model (PCI EPM).
Methods:
Descriptive analysis of HMSA's PCI EPM, including its inclusion criteria, contents of the bundle, target prices, shared savings model, and incentivized quality metrics. We also compare HMSA's PCI EPM to Medicare's Bundled Payment for Care Improvement programs and the cancelled Cardiac Care Model.
Results:
HMSA's PCI EPM was designed through an iterative process with cardiologists and is the first commercial bundle to specifically target a cardiac procedure. PCI EPM incorporates site neutrality and incentivizes providers to shift care to the outpatient setting when medically permissible. Compared to existing non-commercial models, PCI EPM incorporate first-dollar shared savings and incentivized fewer quality metrics.
Conclusions:
Reviewing features of the Percutaneous Coronary Intervention Episode Payment Model in comparison to existing Medicare programs is intended to help guide health plan and health policymakers when designing programs and policies related to cardiac interventions.
Implications:
Bundled commercial payments for interventional cardiology procedures are promising and should continue to be further explored.
Level Of Evidence:
VI.
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