title: Bundled payment fails to gain a foothold In California: the experience of the IHA bundled payment demonstration.
abstract: To determine whether bundled payment could be an effective payment model for California, the Integrated Healthcare Association convened a group of stakeholders (health plans, hospitals, ambulatory surgery centers, physician organizations, and vendors) to develop, through a consensus process, the methods and means of implementing bundled payment. In spite of a high level of enthusiasm and effort, the pilot did not succeed in its goal to implement bundled payment for orthopedic procedures across multiple payers and hospital-physician partners. An evaluation of the pilot documented a number of barriers, such as administrative burden, state regulatory uncertainty, and disagreements about bundle definition and assumption of risk. Ultimately, few contracts were signed, which resulted in insufficient volume to test hypotheses about the impact of bundled payment on quality and costs. Although bundled payment failed to gain a foothold in California, the evaluation provides lessons for future bundled payment initiatives.
authors.affiliation: M. Susan Ridgely (ridgely@rand.org) is senior policy analyst at the RAND Corporation in Santa Monica, California.
authors.forename: M Susan
authors.initials: MS
authors.lastname: Ridgely
authors.affiliation: David de Vries is a research assistant at the RAND Corporation in Santa Monica.
authors.forename: David
authors.initials: D
authors.lastname: de Vries
authors.affiliation: Kevin J. Bozic is the William R. Murray M.D. Endowed Chair in Orthopaedic Surgery and a professor in and vice chair of the Department of Orthopaedic Surgery, University of California, San Francisco.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.affiliation: Peter S. Hussey is senior policy researcher at the RAND Corporation in Boston, Massachusetts.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hussey
mesh_terms: D000328:Adult; D002140:California; D018166:Health Care Reform / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D008875:Middle Aged; D009985:Orthopedics / Q000191:economics*; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D010865:Pilot Projects; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D014481:United States
keywords: Health Reform; Organization and Delivery of Care; Physician Payment
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