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Overview of BPCI (Models 2-4) Evaluation Intended consequences of bundled payments
Lower payments and improve quality?
Internal validity challenges
Challenges in Evaluating Bundled Payments: BPCI and beyond Daver C. - - PowerPoint PPT Presentation
Challenges in Evaluating Bundled Payments: BPCI and beyond Daver C. - - PowerPoint PPT Presentation
Challenges in Evaluating Bundled Payments: BPCI and beyond Daver C. Kahvecioglu, CMMI June 25, 2017 1 Outline of Presentation Overview of BPCI (Models 2-4) Evaluation Intended consequences of bundled payments Lower payments and improve
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Possibly the largest evaluation of bundled payments both in
scope and size
Flexibility Extremely large dimensionality (bundle of
bundles)
3 Models X 6 Episode Initiator Types X 48 clinical episodes X 3 bundle lengths X rolling entry and exit
Separate matched comparison groups needed for many
- f these combinations
New comparison groups needed in each quarter due to rolling entry and exit
Overview of BPCI Models 2-4 Evaluation
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Minimize selection bias in estimated impacts on cost and
quality
At the participant level
At the beneficiary/episode level
BPCI evaluation
Matched comparison episode initiators
Difference-in-differences estimation
Regression-based risk adjustment
Absent randomization, no guarantee that unobserved
differences are not biasing the results
Challenges: Internal Validity
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How generalizable are the results for the U.S. at large? Generally an issue for all voluntary models Will want to estimate impacts on the subgroups of interest
such as Episode Initiators with low use of post-acute care in the baseline
if sufficient sample size
adds to the dimensionality
Challenges: External Validity
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Unintended consequences of bundled payments
Shifts in patient mix?
Shifts in costs?
Unwarranted increase in volume?
Decline in quality?
Need to define and track many metrics – adds to the
dimensionality
Arbitrage: Possibility of exploiting imperfect target prices
Unintended Consequences of Bundled Payments
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Adequate sample size
difficulty reliably measuring important characteristics
Availability of data
functional assessment data not available for all beneficiaries measured at the same time after discharge
Beneficiary survey partially remedies this, but still no baseline data on the beneficiary
Measurement Challenges
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For credible and reassuring evidence on bundled payments,
it is important to
Identify adequate comparison groups (Episode Initiators) for voluntary models
Adjust for the heterogeneity of patients even within specific clinical episodes