Skip to main content

Reimbursing Integrated Care Through Bundled Payments

  • Chapter
  • First Online:
Handbook Integrated Care
  • 2555 Accesses

Abstract

An essential element of making integrated care successful is an appropriate reimbursement instrument, such as bundled payments. They may differ in the scope of bundling (target population, time, sectors), as well as in how the price is set (negotiation, fixed). Yet, they always go along with a specific mind set of taking responsibility for the delivered health care and transparency on the own performance

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Amelung, V. (2019). Healthcare management. Berlin, Heidelberg: Springer.

    Book  Google Scholar 

  • Barnum, H., Kutzin, J., & Saxenian, H. (1995). Incentives and provider payment methods. International Journal of Health Planning and Management, 10(1), 23–45.

    Article  Google Scholar 

  • Benstetter, F., Lauerer, M., Negele, D., & Schmid, A. (2020). Prospektive regionale Gesundheitsbudgets. Internationale Erfahrungen und Implikationen für Deutschland. Heidelberg: medhochzwei.

    Google Scholar 

  • Breyer, F., Zweifel, P., & Kifmann, M. (2013). Gesundheitsökonomik. Berlin, Heidelberg: Springer.

    Book  Google Scholar 

  • Busetto, L., Luijkx, K., Huizing, A., & Vrijhoef, H. (2015). Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: A case study. BMC Family Practice, 16(105).

    Google Scholar 

  • Centers for Medicare & Medicaid Services, CMS. (2020a). Bundled payments for care improvement (BPCI) initiative. Available under https://innovation.cms.gov/innovation-models/bundled-payments. Last accessed on March 25, 2020.

  • Centers for Medicare & Medicaid Services, CMS. (2020b). CMS innovation center. Episode payment models. Available under https://innovation.cms.gov/innovation-models/bundled-payments. Last accessed on April 9, 2020.

  • Centers for Medicare & Medicaid Services, CMS. (2020c). Quality measures fact sheet. Available under https://innovation.cms.gov/files/fact-sheet/bpciadvanced-fs-nqf1550.pdf. Last accessed on April 9, 2020.

  • Charlesworth, A., Davies, A., & Dixon, J. (2012). Reforming payment for health care in Europe to achieve better value. Nuffield trust research report.

    Google Scholar 

  • Chen, L., Meara, E., & Birkmeyer, J. (2015). Medicare’s bundled payments for care improvement (BPCI) initiative: Expanding enrollment suggests potential for large impact. The American Journal of Managed Care, 21(11), 814–820.

    Google Scholar 

  • De Bakker, D., Struijs, J., Baan, C., Raams, J., de Wildt, J. E., Vrijhoef, H., & Schut, F. (2012). Early results from adoption of bundled payments for diabetes care in the netherlands show improvement in care coordination. Health Affairs, 31(2), 426–433.

    Article  Google Scholar 

  • Ellis, R. (1998). Creaming, skinping and dumping: Provider competition on the intensive and extensive margins. Journal of Health Economics, 17(5), 537–555.

    Article  Google Scholar 

  • Ex, P., & Henschke, C. (2019). Changing payment instruments and the utilisation of new medical technologies. The European Journal of Health Economics, 20, 1029–1039.

    Article  Google Scholar 

  • Fahlenbrach, C., et al. (2011). Bonus ohne Extrakosten. Gute Ergebnisse bei Hüft-OPs senken die Behandlungskosten im Folgejahr. Gesundheit und Gesellschaft, 9, 34–39.

    Google Scholar 

  • Forsberg, E., Axelsson, R., & Arnetz, B. (2001). Financial incentives in health care. The impact of performance-based reimbursement. Health Policy, 58(3), 243–262.

    Article  Google Scholar 

  • Goodwin, N., Stein, V., & Amelung, V. (2017). What is integrated care? In V. Amelung, V. Stein, N. Goodwin, R. Balicer, E. Nolte, & E. Suter (Eds.), Handbook integrated care. Cham: Springer.

    Google Scholar 

  • Hussey, P., Ridgely, S., & Rosenthal, M. (2011). The PROMETHEUS bundled payment experiment: slow start shows problems in implementing new payment models. Health Affairs, 30(11), 2116–2124.

    Article  Google Scholar 

  • Iorio, R., Clair, A., Inneh, I., Slover, J., Bosco, J., & Zuckerman, J. (2016). Early results of medicare’s bundled payment initiative for a 90-day total joint arthroplasty episode of care. Health Affairs, 31(2), 343–350.

    Google Scholar 

  • Micklos, J., Pierce-Wrobel, C., & Traylor, J. (2020). The center for medicare and medicaid innovation can be a powerful force to accelerate change, but not without key reforms. Health Affairs Blog.

    Google Scholar 

  • Navathe, A., Troxel, A., Liao, J., Nan, N., Zhu, J., Zhong, W., & Emanuel, E. (2017). Cost of joint replacement using bundled payment models. JAMA Internal Medicine, 177(2), 214–222.

    Article  Google Scholar 

  • NEJM Catalyst. (2018). Innovations in care delivery. What are bundled payments? Available under https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0247. Last accessed on March 19, 2020.

  • OECD. (2016). Focus on better ways to pay for health care. OECD White Paper.

    Google Scholar 

  • Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: Creating value-based competition on results. Boston: Harvard Business School Press.

    Google Scholar 

  • Porter, M. E., & Kaplan, R. S. (2015). How should we pay for health care? Working paper from the Harvard Business School (15-041). Available under https://www.researchgate.net/profile/Sarah_Blackstone/publication/296618989_What_Does_the_Patient_Want/links/5728f84508ae057b0a033c9a/What-Does-the-Patient-Want.pdf. Last accessed on March 25, 2020.

  • Quentin, W., Scheller-Kreinsen, D., Blümel, M., Geissler, A., & Busse, R. (2012). Hospital payment based on diagnosis-related groups differs in Europe and holds lessons for the United States. Health Affairs, 32(4), 713–723.

    Article  Google Scholar 

  • Ridgely, S., de Vries, D., Bozic, K., & Hussey, P. (2014). Bundled payment fails to gain a foothold in California: The experience of the IHA bundled payment demonstration. Health Affairs, 33(8), 1354–1352.

    Article  Google Scholar 

  • Romley, J., & Ginsburg, P. (2018). Improving bundled payments in the Medicare program. USC-Brookings Schaeffer Initiative for Health Policy. Available under https://www.brookings.edu/wp-content/uploads/2018/05/bundling-white-paper_formatted-ad-5-22-18.pdf. Last accessed on April 9, 2020.

  • Rosenthal, M. (2008). Beyond pay for performance—Emerging models of provider-payment reform. The New England Journal of Medicine, 359(12), 1197–1200.

    Article  Google Scholar 

  • Ruggeri, M., Drago, C., Moramarco, V., Coretti, S., Köppen, J., Islam, M., et al. (2018). New professional roles and patient satisfaction: Evidence from a European survey along three clinical pathways. Health Policy, 122(10), 1078–1084.

    Article  Google Scholar 

  • Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. (2018). Bedarfsgerechte Steuerung der Gesundheitsversorgung. Available under https://www.svr-gesundheit.de/fileadmin/user_upload/Gutachten/2018/SVR-Gutachten_2018_WEBSEITE.pdf. Last accessed on March 21, 2020.

  • Stokes, J., Struckmann, V., Kristensen, S., van Ginneken, E., Tsiachristas, A., van Mölken, M., & Sutton, M. (2018). Towards incentivising integration: A typology of payments for integrated care. Health Policy, 122(9), 963–969.

    Article  Google Scholar 

  • Struijs, J., de Jong-van, T. J., Lemmens, L., Drewes, H., de Bruin, S., & Baan, C. (2012). Three years of bundled payment for diabetes care in the Netherlands. Impact on health care delivery process and the quality of care. Bilthoven: National Institute for Public Health and the Environment.

    Google Scholar 

  • Struijs, J., Drewes, H., Heijink, R., & Baan, C. (2017) Netherlands: The potentials of integrating care via payment reforms. The case of dutch diabetes care. In V. Amelung, V. Stein, N. Goodwin, R. Balicer, E. Nolte, & E. Suter (Eds.) Handbook integrated care. Cham: Springer Nature.

    Google Scholar 

  • Struijs, J., de Vries, E., Baan, C., van Gils, P., & Rosenthal, M. (2020). Bundled-payment models around the world: How they work and what their impact has been. commonwealth fund, April 2020.

    Google Scholar 

  • Tol, J., Swinkels, I. C. S., Struijs, J. N., Veenhof, C., & de Bakker D. H. (2013). Integrating care by implementation of bundled payments: Results from a national survey on the experience of Dutch dietitians. Int J Integr Care. Oct–Dec.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Patricia Ex .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ex, P. (2021). Reimbursing Integrated Care Through Bundled Payments. In: Amelung, V., Stein, V., Suter, E., Goodwin, N., Nolte, E., Balicer, R. (eds) Handbook Integrated Care. Springer, Cham. https://doi.org/10.1007/978-3-030-69262-9_22

Download citation

Publish with us

Policies and ethics