BPCI Advanced: Evidence That Value-based Payment Is Here to Stay

Late in 2017, when CMS cancelled two planned mandatory bundled payment programs and decreased the number of participants in a third, many viewed the decision as a blow to healthcare payment reform efforts. But the recent announcement of the BPCI Advanced program proves that CMS remains committed to leveraging value-based payment models to improve patient outcomes and reduce healthcare costs.

About the Program

BPCI Advanced is a voluntary bundled payment program that requires all participants to take on downside risk from day 1 (more on that below). In order to participate, an ACO or health system must choose at least one clinical episode from a select list, for which patient costs will be monitored in the hospital and for an additional 90 days post-discharge. They must also agree to tie financial risk to performance on quality measures, which include hospital readmissions and documentation of advanced care plans. Applications are due on Monday, March 12, with the program beginning on October 1, 2018.

Unlocking (More) Value Through Downside Risk

Why downside risk? Because results from previous Medicare programs suggest that value-based payment is most successful at reducing costs when the arrangement requires healthcare providers to have skin in the game. For example, the Next Generation ACO model, which requires the highest downside risk of all the ACO models, resulted in a net reduction in Medicare spending of $63 million in 2016. In contrast, the Medicare Shared Savings Program, Track 1, which does not require ACOs to take on downside risk, resulted in a net increase in Medicare spending of $72 million in the same year. Given the current estimate that Medicare will run out of money by 2029, CMS can’t afford to ignore the effect of requiring downside risk.

Actionable Tips for Health Systems

All value-based payment programs, regardless of program specifics, require providers across the continuum to work together to coordinate patient care – and BPCI Advanced is no exception. To be successful in this program, health systems will need to collaborate with their post-acute providers, working to ensure low costs after patients leave the hospital. Here are some strategies for reducing post-acute care costs that can be implemented without sacrificing quality of care:

  • Make sure your post-acute providers know which patients are part of a BPCI Advanced bundle episode. If you have specific care coordinators following these patients, discuss plans for collaboration with the post-acute providers.
  • Monitor SNF length of stay and rehospitalizations. Are patients staying in the SNF longer than clinically necessary? Are they remaining in the community post-discharge?
  • Reach out to patients within 48 hours of SNF discharge. Make sure that they understand their discharge plans and have no barriers to compliance.
  • Encourage patients to select high-performing post-acute providers. Educate them about the importance of low rehospitalization rates and high ratings for quality of care.

With an eye toward the future of Medicare, cross-continuum collaboration is likely to become the new normal for providing cost-effective, quality-focused care. Learn more about how CarePort Connect helps hospitals and health systems manage patients across the continuum.