Bundled payment for actinic keratosis management: Pilot evaluation of developed models

Background There is an opportunity to explore alternate payment models in dermatology. Objective To pilot 2 bundled payment models for actinic keratosis (AK) management. Methods A prospective cohort study was conducted during September 2013-June 2016. Consecutive patients were recruited from clinics of 5 dermatologists. Patients had to be adults, have ≥1 year of care at the department, and have a history of AK. A bundled payment strategy was prospectively piloted for 1 year and compared with costs in the prior year. Results Overall, 400 participants were enrolled, and complete data was collected for 254 participants. During the year of bundled payments, actual total annual spending on claims was $70,557, whereas model 1 and model 2 bundled payment models would have totaled $67,310 and $74,422, respectively, for the patient cohort. Patient satisfaction surveys showed no difference in the quality of care. Limitations Single-center study and limited sample size. International Classification of Diseases 9 and 10 codes were used to identify claims and might be inaccurate. Costs were modeled rather than fully implemented. Conclusion Dermatologists should be aware of bundled payment models. More work is needed to elucidate the optimal formulation of a bundled payment for AK management, including the services covered, time delimitation, and risk stratification factors.