BPCI Advanced
Bundled Payments for Care Improvement Advanced
The BPCI Advanced Model is a voluntary episode payment model that bundles the costs of care provided to a Medicare beneficiary during a 90-day Clinical Episode into a single payment. It aims to support healthcare providers who invest in practice innovation and care redesign to better coordinate care, reduce expenditures, and improve quality. Providers become the accountable party in this total cost of care approach, facilitating coordination among the entire health care team.
Innovation
A single retrospective bundled payment and one risk track, with a 90-day Clinical Episode duration. BPCI Advanced takes all the costs of care provided to a Medicare beneficiary during a Clinical Episode and 'bundles' them into a single payment.
The Problem
Often a patient who is admitted to the hospital (or receives an outpatient procedure) relies on doctors who don’t know them well nor have their full medical history. What’s more, the patient’s other doctors, including their primary care doctor, may not be looped in. This can create problems for the patient’s immediate treatment, as well as follow-up care and recovery.
The Solution
The BPCI Advanced Model aims to address these issues by having the BPCI Advanced Participant take responsibility for ensuring the patient’s entire health care team – including the providers from all health care settings – communicate and collaborate on quality and total cost of a patient’s care. The Participant facilitates coordination among the health care team, working to meet the patient’s full needs throughout the duration of the episode of care.
Expected Outcomes
The goal is to provide patients high-quality care, support a successful recovery and reduce the frequency and length of preventable hospital stays and emergency department use.
Strategy
CMS is moving away from individual fee-for-services payment towards a coordinated approach to the beneficiary’s needs. A provider in the BPCI Advanced Model becomes the accountable party in this total cost of care approach.
Model Goals
- Care Redesign
- Health Care Provider Engagement
- Patient and Caregiver Engagement
- Data Analysis/Feedback
- Financial Accountability
Patient Eligibility
A patient enrolled in Medicare Parts A and B for the duration of the 90-day Clinical Episode. There are some exceptions.
- Enrolled in Medicare Parts A and B for the duration of the 90-day Clinical Episode
Provider Eligibility
CMS Benchmarks & Thresholds
operational
population
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