Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model

Launched on October 1, 2018, the Bundled Payments for Care Improvement (BPCI) Advanced Model tests whether the linking of payment for a clinical episode may improve care quality while reducing Medicare price.

This month, the Centers for Medicare & Medicaid Services (CMS) announced a 2-year extension of the program, including a new opportunity for applications. Early in 2023, CMS plans to announce a request for application (RFA) to those eligible to participate in the extended years (2024–2025). For those participating in Model Year 6 and those who previously participated but are no longer active, there will be opportunity to apply for Model Year 7 (2024).

Other changes will be made to improve pricing methodology and encourage engagement among providers and suppliers, including:

• The CMS discount for medical clinical episodes will be reduced from 3% to 2%.
• The Peer Group Trend Factor Adjustment cap for all clinical episodes will be reduced from 10% to 5%.
• Major joint replacement of the upper extremity (MJRUE) will be made a multi-setting clinical episode similar to the major joint replacement for the lower extremity (MJRLE) clinical episode.
• Clinical episodes where beneficiaries are diagnosed with COVID-19 will no longer be excluded from the model.

As CMS continues to strive for better integration of primary and specialty care and cater to an increasingly complex population of beneficiaries, Econometrica is excited to continue our work supporting BPCI Advanced participants in understanding the model’s quality measure submission requirements and their performance in the model. To achieve equitable outcomes, integrated and coordinated care for beneficiaries is essential, and having a health system that is accountable, high-quality, affordable, and person-centered can help achieve that goal.

Please visit the following sites for detailed information on this topic: