backThis article reviews the Centers for Medicare and Medicaid Services Innovation Center’s six bundled payment models, detailing their design, implementation, outcomes in cost savings and quality of care, and strategic shifts emphasizing cost savings, patient choice, and preventive care. Models including BPCI Advanced, the Comprehensive Care for Joint Replacement Model (CJR), the Enhancing Oncology Model, and the upcoming mandatory Transforming Episode Accountability Model (TEAM) are highlighted, while noting challenges, regulatory changes, and future directions in episode-based payment systems.
The article points out that surgical bundled payment models, such as BPCI Advanced and CJR, have generated the most significant cost savings for the Medicare program, and outlines how CMS is moving bundled payment models toward provider accountability, including mandatory participation and assumption of downside financial risk. The TEAM structure is based on experience with earlier bundled payment models, incorporating mandatory participation and downside risk into a bundled payment program for certain surgical episodes. By using bundled payments to encourage the redesign of financial relationships among hospitals, physicians, post-acute providers, and other collaborators, TEAM will also introduce compliance complexity since this model lacks broad fraud-and-abuse waivers and relies instead on Anti-Kickback Statute safe harbors and Physician Self-Referral Law exceptions that call for careful structuring and implementation to assure compliance.