Bundled payments show both positive and negative impact

The introduction of bundled payments for some chronic conditions has both positive and negative consequences, according to an article in the New England Journal of Medicine.  

The study examined the results of the national implementation of bundled payments for diabetes, chronic obstructive pulmonary disease (COPD), and vascular risk management.  For the bundled payments, insurers pay a single fee to a principal contracting entity – a care group, similar to an ACO in America, to cover a full range of chronic disease (diabetes, COPD, or vascular disease) care services for a fixed period. 

Key findings:

  • The amounts that care groups were reimbursed for care bundles varied widely because of insurance negotiations.
  • Almost all care providers reported that the care delivery process improved, likely because roles were clearly defined, which improved care coordination.
  • Transparency of care increased.
  • Questions were raised about the potential conflict of interest of GPs, since they provide and commission care in this mode.
  • Patients' freedom of choice in selecting care providers was negatively impacted, as care groups work with preferred providers. 

The article concludes that there are both positive and negative aspects of bundled payments for chronic conditions, and found that it was too early to assess any impact on quality or cost. 

(Source: New England Journal of Medicine, http://www.nejm.org, March 17, 2011)