# The effect of voluntary bundled payments on vulnerable populations

> **NIH AHRQ R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $396,115

## Abstract

Project Summary
To inform payment policy that promotes parity, this study examines how voluntary bundled payments impact
access and outcomes for racial minorities, ethnic minorities, and individuals with low socioeconomic status
(SES), vulnerable groups that have long faced disparities in health care access and outcomes. This application
aligns with the Special Emphasis Notice Health Services Research Priorities for Achieving a High Value
Healthcare System (NOT-HS-19-011) Priority Area #3: Payment for outcomes. Voluntary bundled payments
could exacerbate existing disparities if participating providers perceive that vulnerable patients’ outcomes are
difficult to manage and avoid participating in the payment model (i.e., provider selection) or participate but
avoid caring for vulnerable groups (i.e., patient selection). It is also vital to understand how impacts on
disparities vary based on providers’ mission and experience caring for vulnerable groups (e.g., safety-net vs.
non-safety-net providers). Such insights are particularly critical for lower extremity joint replacement (LEJR),
congestive heart failure (CHF), and sepsis – the most prevalent procedures and conditions that are both
marked by significant, existing disparities and targeted by voluntary bundled payment programs. The insights
generated by this proposal are also critical given the impact of COVID-19 on both payment reform and health
care disparities. We hypothesize that providers participating in voluntary bundled payment programs will be
less likely than non-participants to be located in markets with a high proportion of vulnerable individuals; that
disparities in access and outcomes will widen for vulnerable patients, as compared to other patients, after
providers start participating in voluntary bundled payments compared to providers that do not participate; that
these effects will vary by racial minority versus ethnic minority status, and interactions between racial and
ethnic minority status and low SES; and that disparities will widen less at safety-net versus non-safety-net
providers.

## Key facts

- **NIH application ID:** 10209434
- **Project number:** 1R01HS027595-01A1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Joshua M Liao
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $396,115
- **Award type:** 1
- **Project period:** 2021-04-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10209434

## Citation

> US National Institutes of Health, RePORTER application 10209434, The effect of voluntary bundled payments on vulnerable populations (1R01HS027595-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10209434. Licensed CC0.

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