John W Urwin1, Robert Bauer2, Jonathan Cunningham2, Tyler Oleksy2, Todd Seto3, Zia Khan3, Emily Oshima Lee4, Jeffrey Tom4, Lauren Kohatsu4, Mark Mugiishi5, Kevin G Volpp6, Amol S Navathe6, Ezekiel J Emanuel5. 1. Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, , USA. Electronic address: jurwin@bidmc.harvard.edu. 2. Navvis Healthcare, St. Louis, MI, USA. 3. Queens Medical Center, Honolulu, HI, USA. 4. Hawaii Medical Service Association, Honolulu, HI, USA. 5. Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA. 6. Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, 19104, USA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, 19104, USA; Corporal Michael J. Cresencz VA Medical Center, Philadelphia, PA, 19104, USA.
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.
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.
Authors: Gitanjali Srivastava; Chelsea Paris; Jessica Johnson; Emma Barnes; Brittany L Cunningham; C J Stimson; Kevin D Niswender; Sabrina J Poon Journal: J Health Econ Outcomes Res Date: 2021-07-01