It’s decision time for BPCI Advanced

· 6 min to read
naviHealth Vice President of Clinical Strategy Gina M. Bruno and Market President of the Central Midwest region Tom Divinnie provide key considerations for organizations assessing BPCI Advanced.

When BPCI Advanced went live on October 1, more than 1,500 providers across the US committed to the new bundled payment program model. As reported last month, about 16% of those participants decided to withdraw from BPCI Advanced. For many reading this, this spring provides an exciting opportunity to expand participation in the program and commit more fully to value-based care.

Recently, CMS announced that the Model Year 3 application period for BPCI Advanced would open in April and they do not intend to offer an additional enrollment opportunity. With the enrollment window expected to open any day now, providers still on the fence about applying should take action now to prepare for the application (You’ll have time to review your historical data later this spring or early summer.).

naviHealth’s Vice President of Clinical Strategy Gina M. Bruno and Market President of the Central Midwest region Tom Divinnie have provided the following key considerations for your organization to assess its value-based strategy in a program like BPCI Advanced.

Where to direct internal focus prior to submitting your application

Implementation is a big lift for BPCI Advanced. Many systems who are participating in BPCI Advanced will need to bring together different stakeholder groups that may not have historically held a forum to work together. You’ll also need to provide an opportunity for communication and alignment among clinicians, case managers and post-acute providers who are involved in discharge to discuss the goals of the program.

You’ll also need to think about your organization’s patient identification strategy. In order to focus on identifying patients who will be contributed to BPCI Advanced, you will need to utilize your data and infrastructure to segment your population in an efficient manner. In other words, there is a lot to accomplish internally in a short amount of time.

Market President
Tom Divinnie
VP of Clinical Strategy
Gina M. Bruno

Bruno and Divinnie co-presented a webinar on how to leverage BPCI Advanced as complementary framework to drive success as a part of your organization’s value-based care strategy. As experts on the BPCI Advanced program, both Bruno and Divinnie believe you should take a look at the following focus areas:

Look around: Get to know the Physician Group Practices (PGPs) that are currently participating in your area. (CMS has posted a full list of participants/episode initiators on their website.)

Because PGPs take precedence over Acute Care Hospital (ACH) participants, it’s important to understand how their participation impacts volume and opportunities for the ACH. You’ll also want to understand what other models, including ACOs in your community, are active, as the interplay between them can change how you prioritize, participate, and partner.

Look within: What are your technology assets? What’s your data infrastructure? How will you identify BPCI Advanced beneficiaries? How ready are you to redesign care? By getting a handle on what resources you have in place internally, you’ll be better prepared to manage change to move forward as an applicant. At this stage, you can start aligning stakeholders across the system, engaging physician leaders and starting to optimize care management workflows.

Look ahead: Review the current request for application (RFA) on the CMS website as you think carefully about participation. We expect the new application guidance to build upon this, so it’s a great place to start. Explore Conveners and other partnerships that can help you accelerate the implementation of a value-based care strategy to drive real results quickly.

Look beyond: The application window is just the start. We’ve seen in the past several years some localized strategies based on reservations on new CMS models. BPCI Advanced can be that center of excellence to help accelerate your value-based care strategy. It can help lay the foundation for new and evolving models that CMS may announce in the future. CMS is eager to provide more opportunities to downsize risk and BPCI Advanced can be a great way to look well beyond this model and position you for success.

But it’s about a systematic approach – not only around what is possible within a health system both in terms of efficiencies and resource applications, but also in care redesign and outcomes with a spillover effect into your patient population. BPCI Advanced is one way to get us over that hump so that a systematic approach leads to quality outcomes for all.

Planning for BPCI Success: Next Steps

By getting a better handle on risk and clarifying your vision now, this period of “clinical discovery” for your organization is time well-spent.

Here are four planning steps to take as the application period opens. For some organizations, you may be well on your way through this list. If you’re just beginning in your path toward value-based care, here are some important steps to take to be better equipped for what’s next:

1. Define your organization’s strategy for value-based care and how it applies to BPCI Advanced.

2. Identify your “change champions” and set a foundation for creating and maintaining change.

3. Draft your application(s)—or work with a Convener as part of their application.

4. Assess clinical care patterns and identify best practices or opportunities for improvement.

By the time you read this, the application period for Model Year 3 may have already opened, so start the conversation with key stakeholders in your organization today, if you haven’t already. Remember, the application is non-binding, so even if your organization decides against moving forward later, you’ve taken an important step in terms of being ready for future value-based care initiatives.

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