Understanding How Bundled Payment Is Changing Postacute Care

The Harvard team will examine changes in PAC strategies deployed by participants under the Bundled Payment for Care Improvement (BPCI) initiative and determine whether they are associated with changes in patient quality and PAC spending. Specifically, the team will examine whether hospitals or physician group practices participating in BPCI demonstrations that cover the conditions now included in mandatory bundled payment show greater change than comparison groups of non‐BPCI hospitals and practices in these outcomes: 1) type, duration, dispersion, or referral patterns for PAC; 2) readmissions rates (as a measure of quality); and 3) PAC‐related expenditures (as a measure of cost). The researchers will analyze whether changes in readmissions and PAC‐related expenditures are associated with specific PAC strategies. In addition, they will assess cost and quality outcomes of hospitals and physicians that selected cardiac conditions.

Targeting policymakers, clinical leaders, private payers, and accountable care organizations, the evaluation results will increase understanding of how providers can or cannot improve care or reduce spending under bundled payment incentives. The project also should help improve the visibility of Center for Medicare and Medicaid Innovation (CMMI) demonstrations overall.