Financial success in BPCI Advanced depends on outperforming risk-adjusted historical data for specific episodes.

With 35 clinical episode types, each with a variety of characteristics, participants need to choose wisely. Take these four key steps toward success.

First, identify clinical champion you can depend on to stay actively involved in the care redesign process. Care teams will need to overhaul the way they deliver patient care–getting them involved early may mean the difference between success and failure.

Make sure you have enough episodes of whichever type you select–the more you have, the better the opportunity to generate enough savings to cover the investment of redesigning care.

Post-acute care utilization and readmission rates can help identify opportunities presented by an episode.  Understanding these opportunities is key for evaluating what investments are needed, which stakeholders to involve, and what might change.

You’ll need to determine the effect CMS’ targets have on each episode type. Comparing your baseline episode experience to the preliminary targets will identify your potential financial savings.

BPCI Advanced presents a great opportunity for practices to gain care management experience and participate in an alternative payment model. Crunch the numbers now—the program’s start date will be here before we know it.

To learn what you can do to prepare yourself to succeed, reach out to DataGen today.




Bundled programs. Should you be participating?

Having loads of data is not enough to answer this. Getting benchmark data seems to be the key, but can be answering the wrong questions.

With BPCI Advanced, comparing yourself against other regional hospitals can only tell you how you are performing overall. Since this program is based on historical baselines, it is much more important to view your own episode cost compositions to identify potential efficiencies.

For example, let’s look at Hospital A. Almost all patients are going to HHA care and about half of patients to either SNF or inpatient rehabilitation. On top of  a significant number of readmissions. This hospital has high costs in almost every category, with significant opportunities for care redesign that leads to cost reductions.

This second hospital already has an efficient baseline and would perform much poorly in BPCI Advanced in this episode type, as there is much less room for care improvement.

Participation in BPCI Advanced or other bundled programs requires attention to an important set of data analytics. To learn more about how DataGen can help with Bundled Payment Programs and analyzing your data, please contact us today at