When Secretary Price said "people have coverage, but they don't have care," he underscored his commitment to one of the core values of bundled payments: patient-centered care. Dr. Price believes that “patients and doctors should be in control of healthcare”; which is why he does not support mandatory pilot programs.” He understands that providers need flexibility, not dictations, to accommodate the needs of their patients.
Dr. Price knows that physicians will need Medicare to accommodate their diverse, local needs in designing payment models. Notably, Secretary Price sees value in voluntary pilot programs, especially the Bundled Payments for Care Improvement initiative (BPCI). During his confirmation hearing, Secretary Price expressed support for voluntary bundled payment models and highlighted the role of the CMS Innovation Center in sponsoring pilot programs, saying that “for certain patients, bundled payments make a lot of sense.”
Expansion and extension of the framework of the BPCI initiative could create a more competitive and long-term approach to bundled payments. Voluntary models should be agnostic to the sponsoring provider; physician groups, post-acute providers and third-party risk-bearing entities have proven highly successful in government and private sector bundled payment programs. For instance, Accountable Care Organizations can use voluntary bundled payments to improve relationships with hospital-based physicians and integrate acute care management into their population health strategy.
Voluntary – not mandatory – bundled payment models engage physicians in the clinical service lines in which they excel. Remedy’s Chief Medical Officer, Dr. Win Whitcomb, bolsters this point in The New England Journal of Medicine, "One of the most important changes spurred by bundles lies in how physicians may adjust the way they practice. Much of the opportunity to improve value lies in removing needless spending during the period following a hospitalization.” Voluntary bundled payment models allow physicians to target those practice patterns with the most opportunity for improvement.
Medicare has a role sponsoring innovation in practice patterns. But Secretary Price doesn’t forget the key role of the local community in healthcare delivery; change starts with clinicians asking policymakers to try something new. And in his words, “The Center for Medicare and Medicaid Innovation is a vehicle that might do just that.”