Whether through repeal and replace or rebrand, changes to the Affordable Care Act are inevitable in 2017. One often mentioned ACA target is the Center for Medicare & Medicaid Innovation, Medicare's test-bed for value-based payment models.
We also know that value-based care has long had bipartisan support. The concept was tested during the George W. Bush administration, and such models as bundled payments—single, fixed payments for services by multiple providers during an episode of care—also have bipartisan backing and momentum.
Bundling was introduced by Medicare through a pair of voluntary demonstrations focused on orthopedic and cardiac procedures: 2009's Acute Care Episode (ACE) and 2013's Bundled Payment for Care Improvement (BPCI), which encompasses acute care and post-acute care. Rapid adoption of BPCI turned into policy through the April 2016 Comprehensive Care for Joint Replacement (CJR), a mandatory initiative based on BPCI's Model 2. Through CJR, approximately 800 hospitals were placed into hospital, physician and post-acute 90-day bundles.
Commercial payers have also embraced bundling, including the nation's largest private payer, UnitedHealth Group, which announced expansion of its bundling initiatives.