What You Can Do Now to Prepare for BPCI Advanced: Smart Episode Selection

One thing the Centers for Medicare & Medicaid Services (CMS) is good at is making us wait. For providers participating in the CMS Innovation Center’s Medicare Bundled Payment for Care Improvement (BPCI) Advanced program, it may seem like that’s all they can do right now as they eagerly anticipate the arrival of their baseline and target price data.

But there are some better options than watching the pot come to a boil. Between now and the start of BPCI Advanced, we’ll be sharing what providers can do to prepare for the program.

As the name would suggest, BPCI Advanced builds on the earlier BPCI program but includes new outpatient episodes for high-volume, high saving potential procedures and a pathway to leverage bundled payments as part of a health system’s overall approach to two-sided, risk-based contracting.

Since BPCI Advanced was announced in January, CMS has provided few details. For those that plan to participate, the question is the same “have the target prices arrived yet”? And the answer as of today – no.

What you can do now is distract yourself by thinking strategically about the bundles that are under consideration to ensure your teams are ready when the data does arrive. While the baseline and target price data will be informative, BPCI Advanced participants should be thinking now about smart episode selection. A great, well-structured bundled payment program could still be financially unsuccessful if the episodes selected don’t have both a substantial savings opportunity and the providers involved can’t influence change.

First, think about what you do know about BPCI Advanced: The baseline period is from 2013 through 2016.

Next, ask yourself: What have you already improved that you can take advantage of now?

• Inventory past improvement initiatives. What has happened relative to clinical redesign in your organization from 2015 to present day? Contact your quality improvement department to inquire about what specific clinical improvement activities have occurred since 2015.
• Understand what metrics were used to monitor past initiatives. Collect and analyze financial and clinical data to determine those episodes that have the widest variation in terms of cost and quality, thereby representing the greatest opportunities for savings. Did the improvements hold? Were the gains sustained? In addition to your internal quality department, also consider contacting your regulatory affairs coordinator. They will often conduct an annual inventory of performance improvement initiatives.
• Check to see if efficiencies gained from past clinical redesign initiatives created cost savings that were not captured in the CMS year 3 baseline period. Selecting a bundle that has been the focus of a successful past clinical redesign late in the performance period is the essence of smart episode selection.

Episode choices are most successful when there are pre-existing evidence-based quality and efficiency metrics that align with bundling’s goal, as well as procedures that can be easily modified to reflect the most appropriate needs of the patient as they move to the next step in their care journey (e.g., post discharge/procedure).

As with all alternative payment programs, preparation is key. And there’s still time! For more on how to achieve success in bundled payments, and BPCI Advanced in particular, download our white paper: Ready, Risk, Reward: Keys to Success in Bundled Payments.