Medicare’s New Bundled Payments: Design, Strategy, and Evolution
Abstract
The Centers for Medicare & Medicaid Services (CMS) is increasingly paying for health care through alternative payment models (APMs) that reward value and quality. Currently, more than 20% of Medicare fee-for-service payments flow through APMs, putting the Administration’s goals of 30% by 2016 and 50% by 2018 within reach.1 These APMs include accountable care organizations (ACOs), bundled payments, and advanced primary care medical homes. In this Viewpoint, we discuss the role of bundled payments.
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Precise cost information based on well-represented patient data may assist payers in adjusting payment policies to further increase efficiency and support new payment initiatives.
“At the same time, precise cost information based on well-represented patient data may also assist payers in adjusting payment policies to further increase efficiency and support new payment initiatives19,20.”
From Early prediction of diagnostic-related groups and estimation of hospital cost by processing clinical notes (2021) · cites this paper as [19]
Cites
Setting Value-Based Payment Goals — HHS Efforts to Improve U.S. Health Care
Burwell, S. M. (2015) · New England Journal of Medicine · doi:10.1056/nejmp1500445 · Cited by 935 · see citing works
CMS—Engaging Multiple Payers in Payment Reform
Rajkumar, R., Conway, P. H., & Tavenner, M. (2014) · JAMA · doi:10.1001/jama.2014.3703 · Cited by 104 · see citing works
Self-citationGuiding Principles for Center for Medicare & Medicaid Innovation Model Evaluations
Howell, B. L., Conway, P. H., & Rajkumar, R. (2015) · JAMA · doi:10.1001/jama.2015.2902 · Cited by 16 · see citing works
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From Volume to Value in Health Care: The Work Begins
Porter, M. E., & Lee, T. H. (2016) · JAMA · doi:10.1001/jama.2016.11698 · Cited by 195 · see citing works
Kline, R. M., Muldoon, L. D., Schumacher, H. K., Strawbridge, L. M., York, A. W., Mortimer, L. K., Falb, A. F., Cox, K. J., Bazell, C., Lukens, E. W., et al. (2017) · Journal of Oncology Practice · doi:10.1200/jop.2016.015834 · Cited by 61 · see citing works
Self-citationLiu, J., Capurro, D., Nguyen, A., & Verspoor, K. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00474-9 · Cited by 50 · see citing works
Malik, A. T., Phillips, F. M., Yu, E., & Khan, S. N. (2020) · The Spine Journal · doi:10.1016/j.spinee.2019.04.024 · Cited by 38 · see citing works
- Authors
- Press, M. J., Rajkumar, R., & Conway, P. H.
- Affiliations
- Centers for Medicare and Medicaid Services (US)
- ORCID
- Rajkumar, Rahul
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-01-12
- Volume
- 315
- Issue
- 2
- Pages
- 131
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2199285561
- Cited by
- 152
- References
- 3
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 4 · 2023: 5 · 2022: 9 · 2021: 10 · 2020: 13 · 2019: 23 · 2018: 35 · 2017: 24 · 2016: 21
- FWCI
- 64.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- bundled payment, Medicare, alternative payment models, accountable care organizations, fee-for-service, health care payment reform, Centers for Medicare and Medicaid Services, primary care medical home
- MeSH terms
- Medicare, Reimbursement, Incentive, United States, Centers for Medicare and Medicaid Services, U.S., Episode of Care, Accountable Care Organizations
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