BPCI-A Participation Can Provide Gains Across the Care Continuum

BPCI Advanced (BPCI-A) application is now open, and remains open until June 24. Recently, you’ve heard us outline the main reasons organizations should apply to the program overall through our blog post and related webinar. And Sg2’s position continues to be: applying for BPCI-A is a win not just for gaining access to episodic spend and utilization data, but also to aid in future decision making for BPCI-A participation. However, you may already be thinking, But what comes next? How do I know if participation is right for my organization?

Sg2 is here to help—similar to our position on BPCI-A application, our position on participation is that if you are not yet involved in BPCI-A, you should give serious consideration to participating in the initiative for the experience it provides with episode payment models.

Should You Apply? Yes!

First of all, let’s quickly recap… CMS is going to release pricing benchmarks for BPCI-A applicants before the participation deadline. In general, as an applicant, you can take advantage of this as a chance to gather valuable episode spend data. Taking it a step further, you can also use this data to determine if your organization can reduce spend, coordinate care and align with physicians before you commit to participation. There will not be another opportunity to apply for this voluntary program.

Furthermore, partnering with Sg2 now, during the application period, allows you to leverage our bundled payment expertise and analytics capabilities to help you analyze your data and make an informed decision about BPCI-A participation.

Should You Participate?

Taking a look at the big picture, BPCI-A participation could help you advance your capabilities in value-based care. We expect mandatory bundled payment programs in 2020, so this represents an excellent opportunity to prepare and succeed. Additionally, this could accelerate your bundled payment strategy—the episode spend data available to participants can be leveraged to inform episode payment models with commercial carriers or self-insured employers. We believe members who participate may enjoy a number of advantages, the most of important of which are:

  1. Gaining experience in managing continuum-based risk—including episodic care and patient transition management across your System of CARE—to help you establish proven bundled payment experience that can be leveraged with employers and other payers
  2. Potentially increasing revenue by capitalizing financially on cost-saving opportunities (ie, if CMS saves money, that money can be shared with you)
  3. Increasing and/or improving physician alignment through gainsharing as well as aAPM qualification under the Quality Payment Program, which provides physicians with an extra incentive to align with your organization in terms of the impact on MIPS reporting requirements and payment adjustments

Simply put, BPCI-A participants will gain valuable experience that can improve performance in other risk models, including commercial and employer contracts. Participants also are likely to improve care coordination and patient experience outcomes, which is a win-win for patients and providers alike.

How Can Sg2 Help?

Sg2’s Consulting team has successfully supported organizations across the BPCI-A application, analysis and participation phases. Once you have applied and received your CMS data, our first step is to assist with stakeholder education and analyze and benchmark your performance to not only help you make the overall decision on participation, but also help determine which episodes present the best participation opportunities.

Note: Sample data are illustrated in this manner for demonstration purposes only and may not reflect exact deliverables.

Beyond analyzing CMS data, your organization must also develop your overall BPCI-A strategy, including what physician/provider alignment structure is best for you, what your top care redesign opportunities are, and, should you participate in BPCI-A, how it will interact with other alternative payment models you participate in.

Sg2’s 20+ years of experience across all 9 Medicare bundled payment demonstrations have earned us the trust of numerous organizations—we can be your partner for comprehensive BPCI-A evaluation and strategy.

Take Action Now

Now that the BPCI-A application period has officially opened, if you have not yet reached out to Sg2 for help, we encourage you to do so! We have experience with robust benchmarking data for best practices and care redesign strategies, as well as expertise in developing and executing hospital physician gainsharing agreements, and we will continue to partner with you as you move from application to the decision to participate. We can also support you in BPCI-A program management should you decide to participate—watch for another blog post from me on how Sg2 can help your organization monitor and manage BPCI-A performance.

In general, Sg2 believes participation in BPCI-A can provide benefits with episode payment models and physician alignment, as well as potential financial opportunity. Our bundled payment team can help you make an informed decision on whether participation is right for your organization, and we can continue to support your program participation later, as well as provide overall guidance for your value-based payment strategies.

For more information, contact us today to talk about BPCI-A program participation:

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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