Presentation (CTI)

OBJECTIVES: Payment models are critical in healthcare and have been applied to improve outcomes, reduce costs, and advance population health. Bundled payment model has been applied to reduce healthcare expenditure by minimizing the utilization of unnecessary services, providing cost-effective services, and improving care coordination. In New Zealand, bundled payment has been applied as Modular payment in the Lead Maternity Carer service. Despite the growing body of literature on bundled payment, there is limited knowledge on what works, how, why, and under what circumstances from an economic lens in implementing bundled payment. This study aimed to develop Economic-sensitive Initial Programme Theories (e-IPT) for the modular payment of the Lead Maternity Carer (LMC) service.
METHODS: We applied four components to generate relevant data for eliciting e-IPT. We interviewed program stakeholders, reviewed existing relevant literature, appraised relevant grey documents, and applied the evaluators’ hunches in our study. We interviewed fifteen policy experts involved with modular payment and employed thematic analysis to identify themes and subthemes. We employed a deductive approach using resources, cost, cost-sensitive context and mechanisms as frames in this study to guide the analysis.
RESULTS: Seven themes and twelve subthemes were identified. We elicited two economic initial program theories structured along demand and supply theories for the modular payment model of the LMC service. Cost-sensitive contexts (public financing, self-employment, training, maternity care policy, advisory notice, modules) and mechanisms (pricing model, choice making, payment schedule, access, equity) were identified. We also identified micro, meso, and macro-organizational levels, and the New Zealand Health System structure as resources related to the economic program theories. The intended outcomes of the modular payment system of the LMC service were also linked. Economic-sensitive CMO configurations were developed for the elicited e-IPT.
CONCLUSIONS: Developing economic initial program theories provides a framework for understanding the implementation of the modular payment system.