How Do Bundled Payment Initiatives Account for Differences in Patient Risk Profiles? A Systematic Review.

Area of Science:

• Health Economics
• Healthcare Policy
• Value-Based Care

Background:

• Bundled payments (BPs) are a growing model for delivering high-value care.
• Accurate accounting for patient risk profiles (PRPs) is essential for BP success.
• Current practices for incorporating PRPs in BPs lack comprehensive understanding.

Purpose of the Study:

• To systematically review and analyze how bundled payment initiatives account for patient risk profiles.
• To identify common methods, stated reasons, and suggested improvements in PRP accounting within BPs.

Main Methods:

• Systematic literature review of BP initiatives in OECD countries up to February 2024.
• Data extraction on initiative characteristics, PRP accounting approaches, and improvement suggestions.
• Thematic analysis and pattern identification across initiatives.

Main Results:

• Ninety-five documents from 17 BP initiatives were analyzed.
• Patient exclusion and risk adjustment were the most common methods for PRP accounting.
• Commonly used risk factors included comorbidities and sociodemographic characteristics; improvements needed in value alignment and data availability.

Conclusions:

• Bundled payment initiatives employ diverse methods to address patient risk differences.
• Approaches to PRP accounting are evolving but often remain rudimentary.
• Transparency in design choices is crucial for cross-initiative learning and comparison.