The Truth About Bundled Payment Pilots and Implementations

Submitted by on Friday, August 8, 2014 - 12:30

Here they go again twisting the truth for the sake of cheap headlines. Don't get taken in – In yet another piece of disingenuous writing that passes for "science", RAND has published an "evaluation" of the IHA's three-year bundled payment pilot. The more thorough explanations from Tom Williams and Jill Yegian are a must for those trying to get to the truth. One of the more astonishing omissions in the official evaluation, and that Tom rightfully highlights, is the choice the IHA made early on to focus on prospectively paid bundles as opposed to what everyone else in the country was and is doing, retrospectively reconciled bundles. There are several reasons why this choice is essential to success – at least for now – and we've explained it in other reports. But let's focus instead on the hyperbole and bias in what's supposed to pass as a serious paper. First, the outrageous statement that the IHA pilot is one of the most visible experiments of bundled payments in the private sector. That might be true if you suffer from severe myopia that prevents you from seeing anything beyond the San Andreas fault. The most visible private sector experiments have been undertaken by Horizon BCBS, BCBS NC, BCBS SC and the private and public sector payers in Arkansas. But wait….none of these have included million dollar payments to RAND for an evaluation, so they can't possibly be meaningful or even truly exist, which is why there's no mention whatsoever of these highly visible programs…. Second, the continuous and false statements about the inability to operationalize bundled payments is more than just galling. It's an insult to all those who have worked tirelessly to make it a reality. As Michael Bailit and Marge Houy wrote in a recent report, health plans have now sufficiently operationalized bundled payments to manage thousands of bundles, not dozens or hundreds.

What this means to you – The bias of these researchers who can only quote their own work as evidence to make their points and ignore everything else is revolting, especially when their work is nothing more than ad hoc interviews. So all they're left with is vague conjecture and the deliberate choice to ignore the truth and spread falsehoods. It's pathetic, but what else should we expect from a dying breed clinging on to the public trough like most of the agents of the status quo. The truth in the real world is easy to spot. Last week CMMI announced a huge surge in the first phase of the BPCI engagement process. The current participants are busy reengineering their processes of care, reducing waste and improving outcomes. Beyond Arkansas, there's a statewide implementation of bundled payments in Tennessee that is actively supported by CIGNA and BCBS of TN. Ohio is poised to be next. And the list goes on. Tom Williams and his colleagues at IHA have produced wonderful lessons from their pilot and resources that will be helpful to others. The fruits of the PROMETHEUS pilots continue to be plentiful as well, and in the next few days HCI3 will make available to the public the definitions of all the episodes it has created in order to further accelerate the pace of current implementations. For those of us in the field, working to actually change the health care system instead of sniping from the top of the ivory tower, the truth is evident and the evidence is clear.