Did the Medicare Bundled Payment Model Decrease Care Quality?

By | January 3, 2023

As we continue to focus on value-based payment models, we must always be aware of possible unintended consequences. The Medicare Bundled Payment for Care Improvement Advanced Model (BPCI-A) is a model that has had broad participation since its inception in 2018. It has shown reductions in overall Medicare payments per episode and improvements in clinical outcomes.

The question arises, were these benefits concerning quality and cost seen across all subtypes of patients? The great concern is, did those with greater frailty and more social issues have the same benefits, or were they negatively impacted by the cost-reducing activities such as decreased post-acute care?

A recent study by Maddox et al. in Health Affairs researched this exact question. They discovered no negative differential changes in clinical outcomes between BPCI-A participants and nonparticipants among patients with medical and social vulnerability. These findings are significant since they indicate that despite our concerns, this model has created incentives for providers and clinicians that does not lead to the avoidance of high-risk patients or reduction of necessary care for those with greater needs. Of note, there was no evidence denoting these selection biases or adverse outcomes.

When studying the needs of those most vulnerable, their costs were higher; however, the new models of care designed within the program still created savings and positive outcomes. Understandably, not all patients have the same needs; so, treating them as individuals within their own dynamics is essential. Still, it is incredibly positive to see that value-based care models supported with value-based payments improve the value for all involved. Furthermore, how we address the concerns is of greater importance. If we avoid trying new models because of their possible negative impact, we will not innovate. We must remember, and recognize, that affordability of care is a significant issue; thus, we must explore various models and study their outcomes to avoid possible situations or unintended consequences that might arise.

Additionally, with a greater focus on health disparities and social factors that impact quality, safety, and cost, we will continue to design models that include those factors. Interestingly, with such focus layered into our conscience and requirements, new models of care will likely increase value to those we serve and positively impact the social factors and disparities we encounter in our current fee-for-service environment. Hence, we recognize these factors play a significant role; therefore, to be successful in our future models, they must receive the focus they appropriately deserve. Let us aspire to deliver on our desires to improve the affordability of care and services for all, with particular attention to those most vulnerable.