Viewpoint: Abandoning bundled payments without further review 'would be a mistake'

Widespread rollback of bundled payments without analyzing the differences between alternative strategies "would be a mistake," according to a blog post in Health Affairs.

The authors, who represent Precision Health Economics and Amgen, wrote bundled payments can effectively manage healthcare use when designed optimally. This is especially true when treating diseases with clear guidelines.

The authors presented a case study comparing the Comprehensive Care for Joint Replacement payment model and proposed changes to bundled payment for end-stage renal disease providers. Whereas the CJR model has appeared to "work well thus far" by aligning a physician's financial incentives with patient health outcomes, ERSD bundled payments have inadvertently shifted some spending to hospitals and infusion centers. 

"These case studies demonstrate that, ultimately, the effectiveness of a bundled payment model will depend on how providers adjust their approach to care," the authors wrote. "Bundled payments are powerful tools for shifting clinician behavior, for good and for bad. Abandoning them wholesale in the face of this risk would be poor health policy. Instead, evidence-based strategies must be used to ensure that shifts in clinician behavior are aligned with the interests of patients and the broader health care system."

For the full Health Affairs blog post, click here

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