Bundled payment is a promising arrangement for encouraging health care providers to improve the value of care. CMS is rapidly expanding bundled payment nationwide in not only voluntary but also mandatory arrangement. There is a critical need to evaluate its impact on patients, hospitals and payers.
The objective of this project is to examine the effects of bundled payment under the BPCI program on the quality and costs of care. We hope this study can provide much needed empirical evidence on the effects of bundled payment and provide guidance on how to design future bundled payment policy in order to improve health care value.
Under bundled payments, hospitals have maintained quality and achieved financial savings for medical condition episodes. However, safety-net hospitals may be less able to achieve the benefits given unique barriers. This project is to evaluate whether the association between bundled payment participation and changes in (outcomes) varied by hospital safety-net status. The study is focusing on the Safety-net and non-safety-net hospitals accepting bundled payments for one or more medical condition-based episodes through BPCI Model 2.
Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact. In this study, we used detailed clinical, demographic, and claims data to identify fee-for-service Medicare beneficiaries who switched to ESRD SNPs offered by a single health plan (SNP enrollees) and similar beneficiaries who remained enrolled in fee-for-service Medicare plans (fee-for-service controls). We then compared three-year mortality and twelve-month utilization rates. Compared with fee-for-service controls, SNP enrollees had lower mortality and lower rates of utilization across the care continuum. These findings suggest that SNPs may be an effective alternative care financing and delivery model for patients with ESRD.
This project is aiming to create a definition for ‘Safety-net’ physician group practices. The 20% sample of Medicare claims will be used to analyze the characteristics of patients served by different groups of physicians.
The objective of this VA-funded pilot study is to assess the impact of the COVID pandemic on access to and utilization of cancer care among Veterans with localized, curable cancers that are primarily treated with surgery and/or radiation.