Why Bundled Care Does Not Always Result in Greater Savings

Researchers supported by the Commonwealth Fund conducted a study researching the statistically significant difference between hospitals participating in Medicare’s new bundled payment program and those that were not. The study focused on five specific medical conditions: congestive heart failure, pneumonia, chronic obstructive pulmonary disease, sepsis, and acute myocardial infarction. Using data collected from 2013 – 2015, the study was meant to determine whether bundled payments were successful in generating shared savings while managing these conditions in different hospitals. Ultimately, their findings concluded no significant difference in cost savings or outcomes, but that is not to say there are no benefits to bundled care.


Key Takeaways:

  1. The presumed success of bundled care was based on earlier studies done on joint replacement patients, which cited an improved cost reduction in Medicare payments. The researchers noted that joint replacement patients were usually younger than patients from the five medical conditions observed in the study. Only 30 percent of joint replacement patients were over the age of 80 as opposed to patients of the five observed conditions, of whom 55 percent were over 80. It is generally accepted that the older a patient is when a given procedure is performed, the more likely they are to experience increased subsequent health risks as compares to a younger candidate for that same procedure.
  2. Patients observed in the study referenced above also had higher rates of disability and poverty. “13 percent of Medicare beneficiaries enrolled in the joint replacement study also had Medicaid, while 11 percent were disabled, compared to 25 percent and 21 percent, respectively, in the new study” (“Has Medicare’s Bundled…”, 2018). Individuals experiencing poverty often neglect early warning signs of more serious conditions due to the cost of treatment, exacerbating the severity of their condition if a serious health concern does arise.
  3. “BPCI hospitals may not have had sufficient ability to incentivize and influence care provided by the skilled-nursing and rehabilitation facilities where patients received post-acute care.” (“Has Medicare’s Bundled…”, 2018). Innovista encourages our readers to view our article “Value-Based Care Reduces Reliance on Nursing Homes”, which details the evolving relationship between hospitals and post-acute care centers, and primary care physicians and their management partner.


 How can Innovista help?

Innovista Health Solutions is a certified MSO and licensed third-party administrator, offering key insights for our physician partners to better understand the value-based sector, and navigate new programs resulting from government legislation. Medicare’s bundled payment program was experimental and has yet to see if the cost reduction and quality of care were improved enough to maintain the program for years to come. Innovista is lead by experts in Medicare Programs including all MSSP tracks, TCM, CCM, and more. As Medicare introduces new programs like Direct Contracting and the Primary Care First Model, Innovista has the staffing and expertise to support existing and new physician partners on the path to navigating change and ultimately driving performance. Ask us how Innovista can come alongside your practice or network to succeed in value-based care.


About Innovista

Innovista exists to help providers succeed in value-based care by developing strong relationships, delivering innovative solutions and driving exceptional performance. Strong dedication to improving patient outcomes drives Innovista to provide our physician partners with expert staffing, clinical programs, delegated services, and analytics capabilities optimized to drive effective change.




Innovista Media Contact

Laura Bingham