Table 3.

Examples of HF Episode Bundles

Characteristic	Arkansas Healthcare Payment Improvement Initiative	Medicare Bundled Payments for Care Improvementa
Launch date	July 2012	April 2013
Patient cohort	Arkansas BCBS, QualChoice, and Medicaid beneficiaries	Medicare beneficiaries
Trigger	HF hospitalization (eligible DRG 291-3)	HF hospitalization (eligible DRG 291-3)
Duration	Episode begins on day of inpatient admission and ends 30 d following discharge	Duration depends on model selected, ranging from inpatient stay only to 30, 60, or 90 d following discharge
Services covered	All HF-related inpatient, emergency department, and outpatient costs	Clinicians choose 1of 4 bundle types, which determine the services and length of care covered. These types include (1) hospital stay only, (2) hospital stay and postacute care, (3) postacute care only, or (4) hospital stay paid prospectively
Payment	FFS service payments billed and received as normal. At conclusion of period, clinician either receives incentive payment or must issue a refund. 2-Sided model with risk bearing and gainsharing split equally between payer and hospital. Risk/gain cannot exceed 10% of allowable claims	Models 1, 2, and 3 make retrospective payments. Model 1 pays a discounted rate for Part A services. Models 2 and 3 pay normal rates but are subject to postepisode reconciliation. Model 4 provides a discounted prospective payment. For all models, clinicians can elect to participate in either phase 1, which is not financially risk-bearing, or phase 2, which is risk-bearing

Abbreviations: BCBS, Blue Cross Blue Shield; DRG, diagnosis-related group; FFS, fee-for-service; HF, heart failure.

^aMedicare episode bundles also exist for acute myocardial infarction, atherosclerosis, cardiac arrhythmia, and chest pain.²⁴