We tried bundles in oncology, but it was a bit of a mess. As I was leaving that space we did get bundles done with United that I felt were reasonable. The challenge is drug costs, oncologists ‘buy and bill’ most of the drugs, so they have an acquisition cost. So bundling drugs is quite a lot of risk.
Most of my work now is shared savings, either pre-post with a cost trend, or regional efficiency, or some blending of the two. We do have some MA deals where we are typically held to an MLR number. Which I get, that’s the world they live in. There is an appetite to move to full capitation, which I’m on the fence about, because I prefer retrospective trends. If you set a cap rate at the beginning of the year the trends could make or break you - would have been a windfall in 2020 with the -8% trends!
Most of our payers use some form of HCC risk adjustment, which is nice. A few either don’t adjust at all or just use age/gender.