BPCI Advanced: The Future of BPCI-A

DATE: 11/25/2019

The Bundled Payments for Care Improvement Advanced program is about to enter its third year. As the program evolves, participants are eager to get a look at their reconciliation reports, which CMS began to release mid-November. The reconciliation results for performance period 1 span clinical episodes that started and ended between Oct. 1, 2018, and June 30, 2019.

As the new model year approaches, what should you be doing to prepare? Here are our thoughts on the next phase of BPCI-A.

Preparing for Model Year 3

Model Year 3 kicks off on Jan. 1, 2020. While the program is showing signs of maturation, participants are still facing numerous challenges, ranging from understanding provider claims data to identifying patients and defining effective strategies.

From a housekeeping perspective, the BPCI-A exclusions list for MY3 is now available — that list and the other resources are all available on CMS’ BPCI-A website.

Engaging with clinicians

Now is the time to engage with your clinicians to get a handle on how they’re feeling about the program and address any issues. Getting appropriate buy-in at the clinical level is critical for program success. It’s a two-way street: stakeholders must be willing to do the hard work to improve care coordination, identify a preferred network and manage the process through completion. Lacking a real commitment to team-based success can be a sure-fire way to lose control of your ability to thrive in BPCI-A.

Strategies for episode selection

Perhaps the most important factor for success in the program is ensuring you participate in the right episodes. Picking the right episodes requires asking fundamental questions:

  • Have you reached critical mass? You need to make sure that you have a high enough volume of episodes to protect yourself if an anomalous and costly episode threatens to wipe out your savings.
  • Do you know the fixed and variable costs of an episode? In acute bundled episodes, acute Diagnosis Related Group payments don’t change, but post-discharge treatment can introduce a lot of variation into cost. Be sure you’ve got a clear idea of what those costs will look like, on average.
  • Do you understand what’s driving costs after discharge? Identifying where it’s clinically feasible to reduce discharges to post-acute care institutional providers, redirect to a lower-cost PAC provider and/or reduce the level of service of the current PAC provider type are key strategies for controlling post-discharge costs.
  • Do you have strategies to reduce readmissions? Reducing acute readmissions is one of the strongest ways to maximize your success rates in bundled programs — but before you can reduce them you need to know why, where and at what point in the episode the readmissions are happening.

BPCI-A continues to evolve, but its challenges are very real. Enrollment in the program is down by 16%, as reflected in this recent article from Medical Economics. We believe the direct and indirect benefits of participation are still worth it — even if just using the program to drive practice transformation. If you’re on the fence, we’d love to hear from you — please reach out today.