Viewpoint: It doesn't matter whether bundles are prospective or retrospective

The debate over whether prospective or retrospective bundles are better is not a productive use of time, two payment reform experts argue in Health Affairs.

Suzanne Delbanco, PhD, executive director of Catalyst for Payment Reform, and François de Brantes, vice president and director of Center for Payment Innovation, claim it is distracting to analyze whether a bundled payment made in advance or after the episode of care is more effective. The authors suggest health system leaders redirect their attention not to the timing of payments, but to the method in which bundles are implemented.

"What matters [are] the incentives being created," they wrote. "Setting a prospective target budget, instituting reasonable downside financial risk, and tying final payment amounts to performance on a set of outcome measures all provide powerful incentives to manage patients well while adhering to a budget."

They also note that alternative payment models bear bigger challenges than when a payment hits. These larger concerns include risk adjustment to account for acutely ill or complicated patients, establishing stop-loss insurance so health systems retain viable margins, devising a set of meaningful and agreed-upon quality measures and setting the percent of upside and downside risk, be it 50 percent-50 percent or another ratio.

Read Dr. Delbanco and Mr. de Brantes' commentary in full here. 

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