The effect of voluntary bundled payments on vulnerable populations

项目摘要 为了向促进平等的支付政策提供信息，本研究检查了自愿捆绑支付如何影响 少数族裔、少数族裔和社会经济地位低的个人的机会和结果 (S)、长期面临医疗保健机会和结果差异的弱势群体。此应用程序 与特别强调通知卫生服务研究优先事项保持一致，以实现高价值 医疗保健系统(非HS-19-011)优先领域3：按结果付费。自愿捆绑付款 如果参与的提供者认为弱势患者的结果是 难以管理和避免参与支付模式(即供应商选择)或参与，但 避免照顾弱势群体(即病人选择)。同样重要的是要了解对 不同的服务提供者的使命和照顾弱势群体的经验不同(例如，安全网与 非安全网提供者)。这样的见解对下肢关节置换术(LEJR)尤为关键， 充血性心力衰竭(CHF)和脓毒症--这两种最常见的程序和情况 以存在显著差异为特点，并成为自愿捆绑支付计划的目标。洞察力 考虑到新冠肺炎对支付改革和医疗保健的影响，这项提案产生的影响也至关重要 护理方面的差距。我们假设，参与自愿捆绑支付计划的提供商将是 与非参与者相比，处于弱势群体比例较高的市场的可能性更小； 与其他患者相比，弱势患者在获得机会和结果方面的差距将扩大 与不参与的提供商相比，提供商开始参与自愿捆绑支付； 这些影响将因少数族裔与少数族裔地位的不同而不同，以及种族与 少数族裔地位和较低的社会保障水平；与非安全网相比，在安全网中的差距将较小 供应商。

Project Summary To inform payment policy that promotes parity, this study examines how voluntary bundled payments impact access and outcomes for racial minorities, ethnic minorities, and individuals with low socioeconomic status (SES), vulnerable groups that have long faced disparities in health care access and outcomes. This application aligns with the Special Emphasis Notice Health Services Research Priorities for Achieving a High Value Healthcare System (NOT-HS-19-011) Priority Area #3: Payment for outcomes. Voluntary bundled payments could exacerbate existing disparities if participating providers perceive that vulnerable patients’ outcomes are difficult to manage and avoid participating in the payment model (i.e., provider selection) or participate but avoid caring for vulnerable groups (i.e., patient selection). It is also vital to understand how impacts on disparities vary based on providers’ mission and experience caring for vulnerable groups (e.g., safety-net vs. non-safety-net providers). Such insights are particularly critical for lower extremity joint replacement (LEJR), congestive heart failure (CHF), and sepsis – the most prevalent procedures and conditions that are both marked by significant, existing disparities and targeted by voluntary bundled payment programs. The insights generated by this proposal are also critical given the impact of COVID-19 on both payment reform and health care disparities. We hypothesize that providers participating in voluntary bundled payment programs will be less likely than non-participants to be located in markets with a high proportion of vulnerable individuals; that disparities in access and outcomes will widen for vulnerable patients, as compared to other patients, after providers start participating in voluntary bundled payments compared to providers that do not participate; that these effects will vary by racial minority versus ethnic minority status, and interactions between racial and ethnic minority status and low SES; and that disparities will widen less at safety-net versus non-safety-net providers.