Meanwhile, one of the major drivers for hospitals in a bundled-payment model is an incentive for deepening their ties to physician specialists. “When you think about ACOs and patient-centered medical homes, there is a patient-centered care model that doesn't translate to the specialists' side,” Hiller said. “Some of our members … see bundles as a way to really pull in and engage with their specialist providers.”
The federal program also builds on successful efforts in the states, which often relied on commercial payers managing their state Medicaid programs. In 2011, Arkansas Blue Cross and Blue Shield partnered with Arkansas Medicaid, the Arkansas Department of Human Services and QualChoice of Arkansas to create a bundled-payment program that launched last year, said Kimberly Hartsfield, now at the Camden Group after spending 20 years with Arkansas Blue Cross and Blue Shield. The insurer also uses a bundled-payment model with Wal-Mart Stores, the nation's largest employer that uses the BCBS affiliate to manage its self-insurance program.
“The intent was to develop a program to more effectively use existing dollars and reduce costs related to duplicated tests, unnecessary procedures and poor coordination of services,” Hartsfield said. She added that bundled payments provide a better introduction to payment reduction and risk-sharing for providers than ACOs because they offer a better picture of what happens once patients leave the hospital.
“Bundled payments are providing an opportunity to align the financial elements appropriately, providing quality and patient-centered care,” she said.
There's general agreement that bundled-payment programs will continue to spread among both public and private payers. The Camden Group's Baggot predicts a shift to more outpatient bundles, particularly for elective outpatient cardiology, orthopedics and spine procedures. Rutledge, the former CMMI official, said this pattern mirrors the shift in healthcare from inpatient to outpatient services, and she expects to see movement with bundled payments in the outpatient setting in the next 12 to 18 months within the healthcare industry as a whole.
One area to watch is oncology, where costs are rising rapidly and 75% to 80% of the care for the 1.4 million new diagnoses each year is handled in outpatient settings, according to Ajay Gupta, a former senior adviser to the CMS who is now COO at Integrated Oncology Network in Corona del Mar, Calif.
“Given the growth in the oncology sector, (and) given the cost growth,” Gupta said, “we feel this is a sector that really has an opportunity for more protocol-driven care that is more effectively coordinated.”
Follow Jessica Zigmond on Twitter: @MHjzigmond