BPCI Data: What To Expect

Regardless of where you stand in the Bundled Payments for Care Improvement (BPCI) program, you will receive a lot of data from CMS. Ranging from claims and ICD-10 exclusion lists to DRG price information, CMS makes a lot of data available to potential and existing participants to make this program a successful one. When considering participation into the program, CMS provides baseline claims from mid-2009 to mid-2012, along with hypothetical DRG-level price information. It's then up to you to figure out not only bundle selection but also risk tracks and period lengths when it is time to move on to phase 2 in the program.

Then, as a participant, you will get monthly files dropped on the CMS secure file server. It's up to you to grab those files, process them, and follow any layout changes there could be (and there were quite a few already) as well as finding another more long-term and secure storage for those files because they are removed from the server after 30 days. This data contains some costs information, but it's up to you to prorate some of the amounts and figure out the total costs and breakdown by episode.

When reconciliation time comes, CMS also provides more files to help with this true-up process, including claims and actual DRG-level price information. Deep knowledge on episode definitions proves valuable here to troubleshoot any discrepancies and end up with fruitful results.

All this data is a gold mine of information as it concerns not only your business but every setting your patients experienced in the past.

Archway Health's roots are deep in the BPCI program. We take care of your data to help you answer questions such as: What are the costs associated with my episodes of care? How are those costs trending over time? How are my key performance indicators trending?

Archway Health goes even further with Archway Carelink, tracking patients during episodes of care so we can even answer questions like: Where are my patients? How are they feeling? Is there a change in condition with the patient that requires an intervention? Is the patient on track with their care plan? How am I doing financially with this patient?

To learn more about Archway Carelink, please visit us at www.archwayhealth.com or contact us at info@archwayha.com.