Basics of Orthopaedic Commercial and Government Bundling

Abstract

Background: The health care system is transitioning from fee-for-service models to value-based care frameworks, with bundled payments emerging as a promising approach to improve cost efficiency and patient outcomes. Bundled payments consolidate costs for multiple services into a single payment for specific treatments or conditions. This study reviews the development and implementation of bundling models in orthopaedics, comparing government and commercial approaches and discussing their benefits and challenges.

Methods: A review of the literature was conducted to examine existing bundling programs in orthopaedics, including Medicare initiatives like the Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement model, as well as commercial programs from insurers such as Cigna and UnitedHealthcare. The review focused on published studies, reports, and case examples to identify trends, outcomes, and barriers associated with these models.

Results: Government programs such as Comprehensive Care for Joint Replacement have demonstrated improved care coordination and cost control but face challenges in engaging physicians and aligning financial incentives. Commercial models, with greater flexibility in their prospective payment structures, allow for customization and better financial predictability but require careful negotiation and compliance with quality metrics. Both approaches highlight the importance of robust data management, multidisciplinary collaboration, and innovative partnerships to improve care delivery. Condition-based bundling, though conceptually aligned with value-based care, remains in its early stages within orthopaedics.

Conclusions: Bundled payment models represent a key strategy for advancing sustainable and efficient health care delivery in orthopaedics. Despite challenges like stakeholder alignment and resource demands, these models offer potential to enhance care quality and reduce costs. Future directions should prioritize collaboration, technology integration, and the resolution of implementation barriers to fully realize the benefits of bundling in orthopaedic practices.

Keywords: Medicare bundling programs; bundled payments in healthcare; cost efficiency and quality care; insurance-based bundled payments; orthopaedic surgery bundling; value-based care (VBC) models.