Question special
Lead Moderator

Bundles, reference pricing, and assembled products have come up several times this week, and I'd like to devote some attention to this theme.

I think of bundles as conceptually on the path of buying an episode of care, but they originate as a CMS administrative fix, so the focus is aligning incentives within the delivery system (inputs) vs. creating a buyer-facing product.

Reference pricing is a payer-driven effort to force some episode-level accountability (the quality emphasis is light so still a closer to the input than output end of the spectrum.)

Wal-mart is increasingly active in shopping based on quality and cost outputs, partnering with places like Mayo and Virginia Mason to provide certain procedures. They encourage employees to get certain complex care (ex. spine surgery) at these 'centers of excellence'. I'm surprised this isn't more common among self-insured firms.

Here are a few of my q's, but feel free to digress!
1. Could/would Medicare becomes an active purchaser...?
2. Practically/clinically how does chronic care work in this paradigm?
3. Political economy challenges seem tough, especially when procedures look like the best place to start....