May 23 2019 Amrita Sehgal, Charles Sauter, Josh Loehrer

Why every provider should apply for BPCI-A

The CMS Bundled Payments for Care Improvement (BPCI) – Advanced program offers participants the opportunity to take on episodic risk on 37 different clinical episode types. Current participants have realized tremendous value in the BPCI-A program through the potential to earn a bonus payment and the experience navigating value-based care programs. The BPCI-A program creates an incentive for providers and care teams to invest in care redesign processes and systems that enable higher-value care delivery. Leading providers have leveraged this experience to expand to commercial bundles and broader value-based care programs.

The new model year begins in 2020 and providers have until June 24th to apply for the program. We believe every provider who is not currently participating in BPCI-A should submit an application by this deadline. Current participants should consider expanding their participation, and if currently using a convener, should consider applying to enter BPCI-A as a self-convened or non-convened participant. Clarify experts have laid out below the benefits of applying for BPCI-A and elements to consider when navigating the application process.

WHY SHOULD YOU APPLY FOR BPCI ADVANCED?

Gain experience in value-based care programs: With mandatory CMS bundles in Radiology, Oncology, and Cardiology on the horizon, BPCI-A provides an opportunity to gain experience in bundled payment models. Don’t wait until bundle programs are mandatory to build the infrastructure and processes required to succeed.

It’s risk-free. Providers can apply for as many clinical episodes as they are interested in, with no obligation to participate in any of them. Submitting this application does not commit applicants to the program.

Get valuable data: CMS will provide historical data on selected episodes from 2015-2018. This data will show acute performance, post-acute performance, and clinical variation. Some of this data is almost impossible for providers to get on their own and can be very informative in driving clinical transformation.

It’s the last time to apply: CMS has indicated that there will be no new windows for providers to apply for BPCI-A, which ends in 2023. If your organization is at all interested in BPCI-A, now is the time to apply!

HOW SHOULD YOU APPLY FOR BPCI ADVANCED?

CMS does not limit the number of applications that providers can submit for the BPCI-A program. Many providers apply as both convened and self-convened. This gives them the option to enroll either way when the time comes in November to make final participation decisions.

Clarify strongly believes there is more value in participating without a convener. For one, you get to keep 100% of your bonus instead of sharing with a convener partner. Additionally, since broader value-based programs are on the horizon, it is important to have independence in navigating the organizational change required to succeed.

WHY WORK WITH CLARIFY?

The #1 solution: Clarify was recently ranked the #1 bundle support solution by Chilmark, a prominent independent market research firm. We were assessed against eight functional categories (e.g., opportunity analysis, quality reporting) and competed against top vendors in the market.

Early diagnostics: Clarify is a CMS “Qualified Entity” and has 100% of identified Medicare claims data. We provide performance insights, peer comparisons, and directional episode recommendations months before CMS will deliver performance data. This gives potential BPCI-A participants more time to realize necessary performance improvements before the program starts and be confident in their episode selections.

Predictive analytics: Clarify uses powerful predictive analytics to generate case-mix adjusted insights on financial and operational performance in BPCI-A episodes. These values are based on a dataset of over 150M+ lives complete with clinical, claims, and social determinants of health history. Through comparing observed performance to our “expected” values, you can isolate granular areas of improvement at the individual physician and patient level. These performance insights are relevant across all value-based care programs.

Real-time insights: Clarify provides real-time target price projections to promote care interventions for live episodes. Our real-time and historical performance analysis highlight improvement opportunities at all times.

Expert Team: We have an expert team of former healthcare strategy consultants, healthcare industry leaders, and clinicians to help you interpret important analytics and provide change management support.

To learn more about the BPCI-A program and stay up to date with our latest BPCI-A content, visit our Resources Page or contact Josh Loehrer at [email protected]

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