Payment

Ochsner Health Network is a leader in providing high quality clinical and hospital patient care in the Gulf South and is the largest Clinically Integrated Network in the region. The objective of this collaboration is to perform detailed analytics on Ochsner data to understand the significant differences in spending between the two patient groups. These analytics will be used to inform 1) MSSP program/intervention design across Ochsner Health System (OHS) and 2) the national policy audience of key findings through publication and dissemination of results.

Under bundled payments, hospitals have maintained quality and achieved financial savings for medical condition episodes. However, certain patients may be more or less likely to experience these benefits given their high clinical, social, or health care utilization risk. This project is to evaluate the association between bundled payment participation and changes in outcomes for high-risk patients. An observational propensity-matched difference-in-differences analysis was conducted using Medicare fee-for-service beneficiaries hospitalized data between 2011 and 2016.

Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross Blue Shield Association, partnered with the Payment Insights Team (and subsequently the Parity Center) from 2017 through 2026. The team initially advised HMSA on the design, implementation, and evaluation of a statewide primary care payment model that transitioned participating providers from fee-for-service reimbursement toward population-based payment. This work examined how financial incentives, performance measurement, and practice characteristics influenced health care quality, utilization, and spending.

The partnership subsequently expanded to include analyses of integrated medical, pharmacy, laboratory, and care-management data. Recent projects evaluated diabetes treatment and monitoring gaps, differences in care across Medicare, Medicaid, and commercial populations, participation and outcomes in HMSA’s care-management programs, and the real-world effects of initiating GLP-1 therapies. Together, this work helped HMSA identify opportunities to improve clinical monitoring, care delivery, medication use, and health outcomes across its member population.

Over nearly a decade, the partnership produced an extensive body of applied research spanning payment reform, behavioral economics, diabetes care, medication use, and population-health management.

This study examines how bundled payments implemented via voluntary and mandatory participation impact access and outcomes among vulnerable patients – evidence needed to inform policymakers about the broader policy impact and whether to scale bundled payments through voluntary and/or mandatory participation.

Cancer drug prescribing by medical oncologists accounts for the greatest variation in practice and largest portion of spending on cancer care. This project evaluated the association between a national commercial insurer’s ongoing pay-for-performance (P4P) program for oncology and changes in prescribing of evidence-based cancer drugs and spending. In all, we found that P4P programs may be effective in increasing evidence-based cancer drug prescribing, but may not yield cost savings.

Under the Medicare fee-for-service Bundled Payments for Care Improvement (BPCI) program, lower extremity joint replacement (LEJR) bundled payments are associated with 2-4% cost savings with stable quality. BPCI may prompt practice changes that benefit all patients, not just Medicare fee-for-service beneficiaries, and magnify the potential benefits of bundled payments. This project is to examine the association between hospital participation in BPCI and outcomes for commercially insured and Medicare Advantage (MA) patients receiving LEJR.

Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact. In this study, we used detailed clinical, demographic, and claims data to identify fee-for-service Medicare beneficiaries who switched to ESRD SNPs offered by a single health plan (SNP enrollees) and similar beneficiaries who remained enrolled in fee-for-service Medicare plans (fee-for-service controls). We then compared three-year mortality and twelve-month utilization rates. Compared with fee-for-service controls, SNP enrollees had lower mortality and lower rates of utilization across the care continuum. These findings suggest that SNPs may be an effective alternative care financing and delivery model for patients with ESRD.

The CJR model was implemented in a group of randomly selected geographic areas to test bundled payment and quality measurement for LEJR. Some hospitals also participate in other payment models, such as MSSP ACOs. The goal of this project is to conduct analysis based on hospital-level outcomes to evaluate whether any benefits derive from the overlap.

This partnership with Blue Cross Blue Shield North Carolina is centered around and evaluating the model (Nova), including use of evidence-based practices, principles from behavioral economics, and econometric measurement techniques, implemented and tested using scientific quasi-experimental and pragmatic randomized trial methods.

Bundled payment is a promising arrangement for encouraging health care providers to improve the value of care. CMS is rapidly expanding bundled payment nationwide in not only voluntary but also mandatory arrangement. There is a critical need to evaluate its impact on patients, hospitals and payers.

The objective of this project is to examine the effects of bundled payment under the BPCI program on the quality and costs of care. We hope this study can provide much needed empirical evidence on the effects of bundled payment and provide guidance on how to design future bundled payment policy in order to improve health care value.