Project Tests Viability Of Bundled Care Payments
The Integrated Healthcare Association (IHA) is
launching a pilot project to test whether episode of care payments
(bundled payments) for specific medical procedures can improve
healthcare efficiency, generate cost savings and improve healthcare
IHA received grant funding for the pilot effort
from the California HealthCare Foundation.
"Bundled payments offer another mechanism to help
align financial incentives for all providers involved in treating a
patient during a discrete episode of care for a specific condition,"
said Thomas R. Williams, executive director of IHA.
Starting in late summer and focusing initially on
commercial PPO patients in Los Angeles and Orange counties, the project
is designed to demonstrate the feasibility of episode of care payments
for total knee or hip replacements. Later phases of the pilot will
expand the types of procedures and include other areas of California.
Episode of care payments have received national
interest as a promising method to improve quality and contain costs. A
report from the Commonwealth Fund Commission on a High Performance
Health System projects that bundled payments for acute care episodes
could potentially reduce national health expenditures by as much as
$300 billion by year 2020.
The episode of care project will test the
feasibility of a reformed payment structure that establishes a single
budget or fee for a procedure that involves multiple providers.
"This innovative pilot will be helpful in
improving understanding of how to best enhance patient care through an
integrated approach to reimbursing physicians and hospitals," said
Thomas M. Priselac, president and CEO of Cedars Sinai Health System in
Los Angeles. "It allows doctors, hospitals, and health plans to work
collaboratively in designing the best way to implement this approach to
reimbursement based on episodes of care."
Participation in the pilot is voluntary and
includes Aetna, Blue Shield of California, CIGNA, HealthNet,
Cedars-Sinai Medical Center, Hoag Hospital, UCLA Health System,
Saddleback Memorial Medical Center, and Tenet-California.
Several independent practice associations and
medical groups will be engaged in this new bundled payment system.
The recently passed national health reform bill
includes Medicare and Medicaid sponsored establishment of national,
voluntary bundled payment pilot programs beginning in 2012.
Address: Integrated Healthcare Association, 300
Lakeside Dr., Suite 1975, Oakland, CA 94612; (510) 208-1740, www.iha.org.