Health Care Spending and Utilization: Evidence from Perinatal Care - - PowerPoint PPT Presentation

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Apr 22, 2023 99 likes •255 views

Effects of Episode-Based Payment on Health Care Spending and Utilization: Evidence from Perinatal Care in Arkansas C A I T L I N C A R R O L L P H D C A N D I D A T E H A R V A R D U N I V E R S I T Y J O I N T W O R K W I T H M . C H E

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C A I T L I N C A R R O L L P H D C A N D I D A T E H A R V A R D U N I V E R S I T Y

J O I N T W O R K W I T H M . C H E R N E W , A . M . F E N D R I C K , J . T H O M P S O N A N D S . R O S E

Effects of Episode-Based Payment on Health Care Spending and Utilization: Evidence from Perinatal Care in Arkansas

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Background

 Bundled payment has been proposed as

alternative to fee-for-service reimbursement

 Recently gained traction in multiple markets

 New payment models use clinical episodes as

basis of payment

 “Episode-based payment” (EBP)  Set fee for entire episode of care  Incentive to reduce ineffective or duplicative services

within episode

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Evidence on Episode-Based Payment

 Voluntary Medicare EBP is associated with lower spending

 Bundled Payments for Care Improvement (BPCI) Initiative1

 Little research has focused on:

 Mandatory EBP  EBP in the commercial market

 Arkansas Health Care Payment Improvement Initiative

(APII)

 Collaboration between Arkansas BCBS and Medicaid  Automatic participation for providers  Applied EBP to perinatal care in 2013  Nearly universal coverage of pregnancies by 2014

1. Navathe et al. (2017); Dummit et al. (2016)

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Research Question

 What was the impact of EBP on the cost and quality

f perinatal care in the commercial market in

Arkansas?

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EBP in Arkansas: FFS with Reconciliation

Adapted from Arkansas Payment Improvement Initiative Materials

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Perinatal EBP in Arkansas

 Principal Accountable Provider (PAP) is provider that delivers baby  Episode includes all pregnancy related care in episode window  Episode exclusions: neonatal care, high risk pregnancies  Risk adjustment based on clinical severity  PAPs eligible for shared savings if quality targets are satisfied

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Research Strategy

 Data: Truven Health MarketScan Commercial

Claims

 Empirical Strategy: Difference-in-Differences

 Study period: 2010-2014  Post-EBP: 2013, 2014  Control Group: states in same or neighboring census

region with statistically similar pre-period trends

 Alabama, Kentucky, Louisiana, Oklahoma  Control variables: maternal and plan characteristics

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Results: Overall Episode Spending

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Decomposing EBP’s Spending Effects

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Results: Price v. Quantity of Inpatient Facility Care

Quantity Measures

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Interpretation of Facility Price Decrease

 Consistent with two broad explanations:

 Shift in referrals to low-price hospitals  Lower negotiated rates for perinatal care

 Lower negotiated rates would decrease prices for

all conditions

 No evidence of price changes outside of perinatal care

 Price changes are concentrated in urban areas

with multiple hospitals

 Consistent with a shift in referral patterns

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Conclusions and Implications

 EBP led to an overall reduction in episode

spending, relative to surrounding states

 At 3.8% savings, our results are consistent with other large

payment reforms

 Spending reductions were driven by inpatient

facility prices. We found no significant reduction in cesarean section rate.

 Future work can explore other clinical areas and

study provider-level changes

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Acknowledgements

 Funding

 Laura and John Arnold Foundation  NSF Graduate Research Fellowship  AHRQ Predoctoral Fellowship

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