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Characterizing a heterogeneous chronic patient population for redesigning person-centred bundled payment models using risk-mitigating measures

Author

Listed:
  • Sterre S. Bour

    (Erasmus University Rotterdam)

  • Lucas M. A. Goossens

    (Erasmus University Rotterdam)

  • Maureen P. M. H. Rutten-van Mölken

    (Erasmus University Rotterdam
    Erasmus University Rotterdam)

Abstract

Since 2010, most Dutch patients with diabetes mellitus type 2 (DM2), an increased risk of cardiovascular diseases (CVR), and chronic obstructive pulmonary disease (COPD), have been treated in single-disease management programs (SDMPs) provided by primary care cooperatives (PCCs). These SDMPs are funded through bundled payments. However, given the prevalence of multimorbidity among patients, there is a growing need for care that is more person-centred. We have previously published an alternative payment model that stimulates the integration of care required for a person-centred approach and in this paper, we demonstrate an operationalization of this model. We performed cluster analysis on claims data to distinguish between different subgroups of patients, predicted cluster probabilities with data available to general practitioners, designed different care packages and investigated the expected financial risk for PCCs of different sizes. We showed that mainly the size of the PCC and the content of the care package influenced the predicted losses or profits for the PCC. Two risk-mitigating measures—risk-adjustment and cost-capping—resulted generally in predicted losses or profits closer to 0, and therefore a reduced risk for the PCC.

Suggested Citation

  • Sterre S. Bour & Lucas M. A. Goossens & Maureen P. M. H. Rutten-van Mölken, 2025. "Characterizing a heterogeneous chronic patient population for redesigning person-centred bundled payment models using risk-mitigating measures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(7), pages 1249-1262, September.
    • Handle: RePEc:spr:eujhec:v:26:y:2025:i:7:d:10.1007_s10198-025-01762-x
    DOI: 10.1007/s10198-025-01762-x
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    References listed on IDEAS

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    3. Karimi, Milad & Tsiachristas, Apostolos & Looman, Willemijn & Stokes, Jonathan & Galen, Mirte van & Rutten-van Mölken, Maureen, 2021. "Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients," Health Policy, Elsevier, vol. 125(6), pages 751-759.
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    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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