Health-Care Patterns for Three Common Elective Surgeries: Implications for Bundled Payment Models

Area of Science:

• Health Services Research
• Surgical Outcomes
• Health Economics

Background:

• Bundled payment models aim to improve value-based care by encompassing all services for a procedure.
• Current bundled payment programs do not include many common elective surgeries.
• Understanding pre- and post-procedure health-care utilization is crucial for designing effective payment models.

Purpose of the Study:

• To assess the timing, duration, and nature of health-care service utilization for three common elective surgical procedures.
• To inform the design of episode-based bundled payment programs for these procedures.

Main Methods:

• Retrospective cohort study using a private insurer's national claims database (2010-2017).
• Included patients undergoing breast reduction, upper extremity nerve decompression, and panniculectomy.
• Analyzed health-care claims for 12 months pre- and post-surgery using interrupted time series analysis.

Main Results:

• Significant differences in health-care service utilization patterns were observed across the three surgical procedures.
• Preoperative utilization increased gradually, peaking at 7-9 months before surgery, with primarily diagnostic and outpatient services.
• Postoperative utilization showed a gradual decline, with limited use of postacute care services, and varied durations (3-6 months).

Conclusions:

• Elective surgical procedures exhibit distinct health-care utilization profiles.
• Bundled payment models should be tailored to the specific timing and duration of utilization for individual surgical procedures.
• This approach can optimize value-based care for surgeries not currently covered by bundled payments.