Coordination-based payments: Assessment and recommendations for their development in France

Abstract

Demands for new payment systems are emerging, to move away from activity-based funding and increase coordination of care. Different coordination-based payment systems exist. Among them, bundling payments for defined episodes of care or for a specific pathology is considered as a promising option. We aimed to better understand how to develop and evaluate such payment systems. For that, we conducted a literature review, exploring articles published in Medline, Econlit and Cochrane®. 569 articles were identified, among which 39 papers were finally retrieved in the study. Limited evidence on their impact has been shown, despite a few positive outcomes to mention. On the first hand, the review highlighted potential pitfalls associated with the development of new payments systems such as the level of integration of the different stakeholders, the transfer of risk from payer to providers, and the variability in care pathways. On the second hand, key milestones in the design of a new payment system were identified. First, after choosing the payment model, care providers have to agree on a standardized care pathway. Second, they have to calculate the right amount of money and define quality criteria to adjust the payment accordingly. Third, the review showed that how the money will be distributed among the different stakeholders will condition its implementation. Finally, external evaluations of such payment systems have to be conducted to assess the added value of new payment systems. Such review provides significant information while considering the development of bundled payments in the French context.