Christopher M. Whaley (
Christoph Dankert is senior vice president of provider partnerships at Carrum Health, in San Mateo, California.
Health Aff (Millwood). 2021 Mar;40(3):445-452. doi: 10.1377/hlthaff.2020.01488.
Bundled payment has shown promise in reducing medical spending while maintaining quality. However, its impact among commercially insured populations has not been well studied. We examined the impacts on episode cost and patient cost sharing of a program that applies bundled payments for orthopedic and surgical procedures in a commercially insured population. The program we studied negotiates preferred prices for selected providers that cover the procedure and all related care within a thirty-day period after the procedure and waives cost sharing for patients who receive care from these providers. After implementation, episode prices for three selected surgical procedures declined by $4,229, a 10.7 percent relative reduction. Employers captured approximately 85 percent of the savings, or $3,582 per episode (a 9.5 percent relative decrease), and patient cost-sharing payments decreased by $498 per episode (a 27.7 percent relative decrease).
打包支付在降低医疗支出的同时保持质量方面显示出了前景。然而，其在商业保险人群中的影响尚未得到很好的研究。我们研究了在商业保险人群中实施一种针对骨科和外科手术的捆绑支付计划对住院费用和患者自付费用的影响。我们研究的项目为选定的提供者协商优惠价格，这些提供者涵盖手术以及手术后 30 天内的所有相关护理，并免除接受这些提供者护理的患者的自付费用。实施后，三种选定的手术的住院费用下降了 4229 美元，相对减少了 10.7%。雇主获得了大约 85%的节省，即每个病例 3582 美元（相对减少 9.5%），患者自付费用每个病例减少了 498 美元（相对减少 27.7%）。
