Healthcare utilization and costs for cardiovascular diseases across different levels of bundled payment adoption in general practice: a data linkage study.

Background
Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands.

Objective
This study assesses changes in healthcare utilization patterns and costs for CVD between 2014 and 2019, while investigating the potential association with bundled payment adoption.

Method
We studied patients at very high risk for CVD with routinely recorded nationwide healthcare data, using an observational study design. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2014 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs.

Results
The odds of medical specialist involvement declined over time for the 152,591 unique patients included in our study. Practices with a higher level of bundled payments had lower odds of medical specialist involvement. Medical specialist costs did also significantly decrease between 2014 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments.

Conclusion
Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do suggest that due to bundled payments more patients are actively monitored.