by Keely Macmillan
The Centers for Medicare and Medicaid Innovation (CMMI) has opened the application window for the Bundled Payment for Care Improvement Advanced (BPCI-A) program for the third and final time. Through May 31, 2023, provider organizations can submit a non-binding application to participate in the program’s two additional model years.
The program extension may be an opportunity to work towards or reinforce value-based care (VBC) goals, better align specialty care with existing population health initiatives, and earn additional Medicare revenue. Participants also benefit from greater flexibility to innovate and strengthen physician alignment through access to certain fraud and abuse waivers, and can use the additional model years to help prepare for CMS’ future mandatory model. For prior BPCI-A participants that had been participating with a convener, the new open window period offers an opportunity to re-enter the model under their own contract with CMS.
The program extension was announced by the Centers for Medicare and Medicaid Services (CMS) last fall as part of its update on their value-based specialty care strategy. In its update, CMS outlined short term and long-term goals to support the integration of specialty care with primary care and Accountable Care Organizations (ACOs), discussed BPCI-A program improvements aimed at sustaining and growing participation in the model, and announced plans to develop a new mandatory, acute episodic payment model over the next 3‒5+ years to support access to high quality, integrated specialty care.
BPCI-A has generated some favorable results to date, including the reduction of skilled nursing facility and inpatient rehab facility spending and a small decline in readmissions in Model Year 3. The program’s first three model years did not generate net savings to Medicare, though a series of model revisions implemented over the past couple years may shift ongoing program evaluations. A two-year extension to the program will allow further testing of model changes including a favorable change to the discount factor, a more predictable retrospective trend factor and the inclusion of outpatient upper extremity joint replacement procedures.
By applying to the program, hospitals, physician group practices and ACOs can access baseline data for the full continuum of care across all episodes. Applicants are expected to receive baseline data and preliminary Target Prices in September 2023 and will be required to submit a signed participation agreement in December 2023, before go-live on January 1, 2024.
Key takeaways for potential participants
- BPCI-A participation provides a vehicle to better align primary and specialty care and reinforce VBC goals
- Recent model changes offer new reasons to consider joining or reentering the program
- Participants are required to accept two-sided financial risk for full clinical episode service line groups, and should understand their organizations’ risks and opportunities before deciding to move forward
As your organization evaluates the BPCI-A program and other VBC opportunities, reach out to our Value-Based Care Strategy Consulting experts for help with your initiatives and goals.