Issue: Understanding the impact of bundled-payment models on value in health care requires a better understanding of how design choices and implementation strategies affect cost and quality.

Goal: To describe the key design elements of bundled-payment models and evaluate empirical evidence about their impact on quality of care and medical spending.

Methods: Scan of the scientific and grey literature.

Findings and Conclusions: We identified 23 initiatives in eight countries that have implemented bundled-payment models, focusing on procedures such as total joint replacements and cardiac surgery, as well as chronic conditions like diabetes and breast cancer. Of the 35 studies retrieved, 32 reported effects on quality of care and 32 reported effects on medical spending. Twenty of 32 studies reported modest savings or a modest reduction in spending growth, while two studies (both based on the same initiative) demonstrated increased spending in the early years of the bundled-payment model’s implementation. Eighteen of 32 studies reported quality improvements for most evaluated measures, while other studies showed no difference in measured quality. Our study provides evidence that bundled-payment models have the potential to reduce medical spending growth while having either a positive impact or no impact on quality of care.

Authors: Struijs, J, de Vries, E. F., Baan, C. A., van Gils, P. F., & Rosenthal, M. B.

Publication Date: April 6, 2020

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