Bundling Care and Payment: Evidence From Early-Adopter

Produced by the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health, University of Toronto.Bundling care that rightly belongs as part of a single care pathway is a common-sense approach to optimizing care, cost and outcomes. Payment for bundles of care with a predetermined price has implications for accountability, risk, and performance management. The extent and focus of the implementation of bundled care and payment can vary widely. Best practice recommendations for payers and policy makers to implement bundled care and payment are not available. In this report we outline the range of options for bundling care and payment, describe what early adopters have done and achieved, and highlight lessons to be learned from the early adopters. We conducted a scoping review to identify the various bundled care programs currently in place and the evidence surrounding them. We selected five programs for detailed review representing a range of bundled care options from procedure-based bundles to more comprehensive capitation-based bundles that also had rigorous evaluative evidence available and in some cases have resulted in widespread implementation. We identified 12 factors for consideration prior to implementing bundled care and payment that were recurring themes from the five case studies, as well as from other bundled care literature.Supported by the Ontario Hospital Association