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Designing a commercial bundle for cardiac procedures: The Percutaneous Coronary Intervention Episode Payment Model
- Source :
- Healthcare. 9:100426
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Cardiac interventions account for a significant share of overall healthcare spending and have been the focus of several large-scale interventions to develop effective bundled payments. To date, however, none have proven successful in commercially insured populations. In 2018, we worked with Hawaii Medical Service Association (HMSA), the Blue Cross Blue Shield of Hawaii, to design a novel commercial bundled payment for percutaneous coronary interventions, the Percutaneous Coronary Intervention Episode Payment Model (PCI EPM). Methods Descriptive analysis of HMSA's PCI EPM, including its inclusion criteria , contents of the bundle, target prices, shared savings model, and incentivized quality metrics. We also compare HMSA's PCI EPM to Medicare's Bundled Payment for Care Improvement programs and the cancelled Cardiac Care Model. Results HMSA's PCI EPM was designed through an iterative process with cardiologists and is the first commercial bundle to specifically target a cardiac procedure. PCI EPM incorporates site neutrality and incentivizes providers to shift care to the outpatient setting when medically permissible. Compared to existing non-commercial models, PCI EPM incorporate first-dollar shared savings and incentivized fewer quality metrics. Conclusions Reviewing features of the Percutaneous Coronary Intervention Episode Payment Model in comparison to existing Medicare programs is intended to help guide health plan and health policymakers when designing programs and policies related to cardiac interventions. Implications Bundled commercial payments for interventional cardiology procedures are promising and should continue to be further explored. Level of evidence VI.
- Subjects :
- medicine.medical_specialty
media_common.quotation_subject
medicine.medical_treatment
Psychological intervention
Medicare
Hawaii
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Health care
medicine
Humans
030212 general & internal medicine
health care economics and organizations
Aged
media_common
Descriptive statistics
Interventional cardiology
business.industry
Health Policy
Percutaneous coronary intervention
Evidence-based medicine
Blue Cross Blue Shield Insurance Plans
Payment
medicine.disease
United States
Conventional PCI
Medical emergency
business
Patient Care Bundles
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 22130764
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- Healthcare
- Accession number :
- edsair.doi.dedup.....759492898421ed1e618cd85b93f1a563