September 14 2018 By: Adam Travis, MD

CMS leaves BPCI Advanced participants wanting more data

CMS’ recent announcement regarding the contents of the monthly claims data that will be provided to BPCI Advanced (BPCI-A) participants indicates that this data will be limited for providers hoping to gain a full understanding of the drivers of episode claims costs and get direction for how to improve performance in the program.

Since BPCI-A participants will only be provided summary claims files for care defined as part of the official BPCI episode but no claims for care immediately preceding the episode or for care during the episode that is not counted as part of the episode, there is limited insight to be gleaned on underlying patient factors driving complexity of care. Clarify Health is uniquely equipped with complete Medicare data and a state-of-art analytics engine to fill in this gap for you. As a Medicare Qualified Entity, we possess the complete Medicare part A, B, and D data sets, allowing us to provide much more detail about patient risk and better engage clinicians with patient-specific insights on how to improve performance.

Physicians trust and engage with this data because we’re able to provide precise case-mix adjustment and peer-to-peer comparisons. Linking a growing database – which currently represents 1/3 of the U.S. population – to clinical and social determinants data at the individual patient-level also enables Clarify to provide performance insights on hundreds of different utilization and quality metrics inside the episode.

Clarify is also the only vendor that uses claims data to replicate the episode target price at the patient-level as CMS will do, which means that Clarify is also the only vendor that can tell you exactly how your net payment reconciliation amount (NPRA) is trending for each episode throughout the performance year. In short, Clarify is the only vendor that provides you a complete understanding of both up-to-date BPCI-A financial performance along with specific areas of justifiable clinical improvement leading to improved financial performance.

To learn more about our methods, download our BPCI Advanced eBook.

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