Take Advantage of BPCI-A for Bundled Payment Success


View our May 7 webinar, BPCI Advanced: The Time Is Now, on demand:

Over the past few weeks, Sg2 members have heard us talk about CMS adding a second cohort to BPCI Advanced (BPCI-A), and the addition of outpatient total knees to this voluntary program, which provides utilization and spend data for hospitalization plus 90 days of the episode. The application period for the second cohort opened April 24 and will only be open until June 24. Sg2’s stance remains that application, and even participation, is an opportunity not to be missed. Episode payment models—in all their various forms—will stand the test of time, and there are strong reasons for health systems to take advantage of BPCI-A to advance their overall value-based payment strategy.

What Is BPCI Advanced?

As a refresher, BPCI-A is a CMS bundled payment program designed to further test a reimbursement mechanism that will fundamentally alter the reimbursement landscape. Organizations (ie, hospitals or physician groups) can elect to participate in BPCI-A by selecting from a menu of 30+ inpatient and outpatient clinical episodes, and there is no minimum number of episodes required for program participation. When a provider selects episodes, they will be responsible for managing not only the acute hospital stay for each patient, but also most services provided to patients in the 90-day postdischarge time frame.

Medicare challenges BPCI-A participants to reduce CMS’s historical spend for this acute and post-acute time frame and will reward organizations able to do so. As an incentive to participate, CMS will release pricing benchmarks in advance of the participation deadline. Organizations can then determine if they can reduce spend, coordinate care and align with their physicians before committing.

Should You Apply?

Our position, from the first cohort to now, is that if you are not yet involved in BPCI-A, you should give serious consideration to submitting an application immediately for 3 key reasons:

  1. The application is nonbinding—your organization is not committing to participation when you apply;
  2. Applicants gain access to insightful episodic spend and utilization data from CMS, which is information that has not typically been available before; and
  3. If you don’t apply now, you most likely won’t be able to join later, as CMS is indicating this is the last window of opportunity.

In general, consider the application period as an opportunity to collect valuable data that will help you make informed decisions about bundled payment participation, whether that’s through CMS, commercial payers or directly with employers.

Partnering with Sg2 and taking advantage of our bundled payment expertise and analytics capabilities can also help you mine the raw CMS data and develop BPCI dashboards to help you visualize your performance and isolate your opportunities.

Take Action Now

The first step to BPCI-A success is to put together the right team. With more than 20 years of experience in bundled payment models, including all 9 Medicare bundled payment programs, Sg2 can help your organization successfully navigate BPCI-A—from application to managing the program should you decide to participate. Stay tuned for more blog posts from me on the particulars of analyzing your data to determine whether participation in the program is right for you, as well as how to achieve and maintain BPCI-A program success.

Overall, we believe BPCI-A application, at the very least, offers an episode spend data opportunity that should be taken advantage of. As the application period opens, our team can provide advice on the benefits of applying to BPCI-A now and, in the future, provide continued support for the program, as well as your bundled payment strategies.

Contact us today to get your application started:

Jim Reilly, Sg2 Senior Principal:


Fill out the form below with the pertinent information, and someone from our bundled payment team will reach out to you.

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