BPCI Advanced: The Next Step in the Transition to Value-Based Care

Added on Mar 2, 2018

By Marie Castelli, Senior Director of Strategy

AvatarIn early January, the Centers for Medicare & Medicaid Services (CMS) announced the Bundled Payments for Care Improvement (BPCI) Advanced program—the agency’s next step in a steady march toward paying for value in health care in the United States.

Bundled payment programs, both those arranged by CMS and by private payers, are designed to align incentives to promote high-quality, efficient care that truly improves outcomes for patients. Press Ganey supports our clients in transforming care delivery through a strategic, integrated focus on safety, quality, patient experience and caregiver engagement—all keys to success in delivering value-based care.

Participation in bundles, as well as the decision to meet the non-binding March 12, 2018 deadline for BPCI Advanced, is critical for providers who want to build their expertise in delivering value-based care, and for those seeking to have their program qualify as an Advanced Alternative Payment Model under the Merit-based Incentive Payment System (MIPS).

Slated to launch on October 1, 2018, the BPCI Advanced program builds on the success of the earlier CMS bundled payment programs. It will consolidate the four original models into a single model that uses consistent methodology and reduces complexity, making it easier for specialist physicians to participate. The new model covers 29 inpatient bundles that represent over 55% of all inpatient Medicare spending, plus 3 outpatient bundles.

Some of the changes under the new program are challenging. For example, all providers in BPCI Advanced must now assume downside risk, and standardized payments are calculated using new models for risk and peer adjustment. Even for providers with significant experience in delivering value-based care, developing and executing on participation can be complex.

One constant in the journey to value-based care is the need for a comprehensive strategy for success. Convener organizations support providers in achieving success through expertise and tools to manage and deliver care under the programs, optimizing networks of care and providing resources to co-manage patients. Organizations serving as conveners include Archway Health, Avant-garde Health, DataGen, naviHealth, Remedy Partners, and Signature Medical Group, among others. Resources to help understand and participate in BPCI Advanced are linked below.

Archway Health webinar on Wednesday, March 7 at 3pm EST

naviHealth solutions for providers

Remedy Partners BPCI Advanced webinars