But there is a trend that threatens to make bundled payment even more difficult to implement for non-Medicare beneficiaries.
Most bundled payment or capitation programs are designed for HMO members – because it’s easy to attribute patients to a specific health care system. The much-ballyhooed Blue Cross of Massachusetts Alternative Quality Contract is only administered for HMO members. HMOs also tend to be fully insured – so that the health plan arranging the bundled payment or capitation can do so without asking for permission from dozens (or hundreds) of self-insured accounts which have the ability to design their own plans. Self-insured employers are leery of alternative payment mechanisms –and it’s difficult to arrange and administer capitation for a multitude of health plans with tiny differences.
The pull to self-insured status is inexorable for employer-sponsored health plans because: