1Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; 2Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; 3Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, Pennsylvania; 4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; 5The Wharton School of Business, University of Pennsylvania, Philadelphia, Pennsylvania; 6Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; 7Department of Medicine, University of Washington School of Medicine, Seattle, Washington; 8Value and Systems Science Lab, University of Washington School of Medicine, Seattle, Washington.
Disclosures
Dr. Navathe reported receiving grants from Hawaii Medical Service Association, Anthem Public Policy Institute, Cigna, Healthcare Research and Education Trust, and Oscar Health; personal fees from Navvis and Company, Navigant Inc., National University Health System of Singapore, and Agathos, Inc.; personal fees and equity from NavaHealth; equity from Embedded Healthcare; speaking fees from the Cleveland Clinic; serving as a board member of Integrated Services Inc. without compensation, and an honorarium from Elsevier Press, none of which are related to this manuscript. Dr. Dinh has nothing to disclose. Ms. Dykstra reports no conflicts. Dr. Werner reports personal fees from CarePort Health. Dr. Liao reports textbook royalties from Wolters Kluwer and personal fees from Kaiser Permanente Washington Research Institute, none of which are related to this manuscript.
Accountable care organizations (ACOs) and bundled payments represent prominent value-based payment models, but the magnitude of overlap between the two models has not yet been described. Using Medicare data, we defined overlap based on attribution to Medicare Shared Savings Program (MSSP) ACOs and hospitalization for Bundled Payments for Care Improvement (BPCI) episodes at BPCI participant hospitals. Between 2013 and 2016, overlap as a share of ACO patients increased from 2.7% to 10% across BPCI episodes, while overlap as a share of all bundled payment patients increased from 19% to 27%. Overlap from the perspectives of both ACO and bundled payments varied by specific episode. In the first description of overlap between ACOs and bundled payments, one in every ten MSSP patients received care under BPCI by the end of our study period, whereas more than one in every four patients receiving care under BPCI were also attributed to MSSP. Policymakers should consider strategies to address the clinical and policy implications of increasing payment model overlap.
The authors thank research assistance from Sandra Vanderslice who did not receive any compensation for her work. This research was supported in part by The Commonwealth Fund. Rachel Werner was supported in part by K24-AG047908 from the NIA.
