So you think you can succeed in BPCI Advanced? 4 steps for day one success


Hospitals and providers accepted into the Bundled Payments for Care Improvement Advanced program will be the first to test CMS' latest voluntary Medicare payment model that begins on Oct. 1.

The model, which runs through Dec. 31, 2023, includes 29 inpatient and three outpatient clinical episodes. Important differences exist between CMS' latest model and its predecessor, the voluntary Bundled Payments for Care Improvement, launched in 2013. Hospitals and providers in BPCI Advanced's first cohort must keep abreast of the program's unique requirements. Success on day one will depend on it.

Tamara Cull, DHA, senior vice president of Aveus, the consulting division of population health management solution provider Medecision, told attendees during a May 30 webinar hosted by Becker's Hospital Review that BPCI Advanced's requirements may appear daunting, but most hospitals have already built the foundation to adopt this innovative model.

Here are four steps for providers as they prepare for BPCI Advanced.

1. Know the differences between BPCI and BPCI Advanced 

There are notable differences between BPCI and BPCI Advanced, and providers must address these variances. Four significant changes include:

  • BPCI Advanced is a single retrospective bundled payment and two-sided risk track, with a standard 90-day clinical episode duration. Participants will no longer be able to choose between 30, 60 and 90-day bundles
  • Outpatient clinical episodes are included in the model for the first time
  • Physicians will be allowed (and encouraged) to lead teams in the new program
  • BPCI Advanced qualifies as an Advanced Alternative Payment Model under CMS' 2019 Quality Payment Program

During the webinar, Dr. Cull encouraged participants to "stretch yourself and participate not only in the inpatient model, but also the outpatient areas."

2. Don't start with a fresh palette — reconfigure existing care redesign tactics

BPCI Advanced participants will need to invest in staff training and infrastructure changes. However, building an entire model solely for BCPI Advanced could drain resources unnecessarily. Instead, providers can turn existing care redesign programs into scalable, payer-agnostic models.

"A lot of the teams we work with already have ongoing care redesign efforts," Dr. Cull said. "Encourage your team to look where you are already spending time and resources, and determine if there is a possibility to align that work with this new model."

3. Proceed with a team

A successful a BPCI Advanced rollout requires expanding relationships with key stakeholders: physicians, health systems, payers, and post acute care organizations. Relationships with team members who touch the patient at every step of the care journey are essential to longitudinal patient care.

It's also important that team members identify and prioritize a few select initiatives they believe are mission-critical for a seamless BPCI Advanced launch. Stakeholders may bring 100 ideas to the table, but only need 25 for success on day one. Teams need to collaborate effectively with other members outside their daily interactions to address the most impactful goals.

4. Consider expert advice

Dr. Cull noted the programs' complexity may require some organizations to seek outside expertise to make sure they're using best practices. 

"These are complex programs and typically need to be woven into other work that you're doing in your organization," Dr. Cull said. "We are seeing a lot of organizations enlist the help of advisors with experience in executing these new care models to help them achieve success faster, instead of trying to work on these models alone." 

Medecision's advisory teams offer strategy, innovation, and customer experience consulting as well as best-practice clinical workflow design, medical and utilization management program optimization, and government program and accreditation compliance.

Missed the deadline for BPCI Advanced's first round? Watch for round two

The application for the upcoming round of BPCI Advanced closed on March 12, 2018. However, CMS is currently accepting applications for its second round of the program set to launch in January 2020.

Access a video of the webinar recording here.
To learn more about Medecision, click here.

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