Providers Flock to BPCI Advanced for More Than Just the Savings

BPCI Advanced has been a hit with providers, which has CMS expressing enthusiasm for the level of interest in the new program.

In a recent Archway Health webinar, we polled 80 providers to capture why they applied to BPCI Advanced and what they hope to gain from the program.

Opportunity for New Revenue

Not surprisingly, the primary reason many providers have applied to participate in BPCI Advanced is to seize the opportunity to generate more revenue for their organization. More than three-quarters of respondents, 77%, said they applied because of the “opportunity for new revenue.”  

The new applicants have likely seen and heard about the revenue generated by their peers who participated in the original BPCI program. Archway’s partners in BPCI earned on average $3,000 per episode of care. And now with best practices and a second-generation of the program, providers in BPCI Advanced will be able to achieve even better results.  

Automatic Bonus

The opportunity for providers to generate revenue with BPCI Advanced is twofold. In addition to the rewards for efficient and effective care, BPCI Advanced participants that meet certain requirements will automatically qualify for a bonus that is awarded to those in the Advanced Alternative Payment Model (APM) track under MACRA. Nearly half of survey respondents, 45%, said they applied to BPCI Advanced “to qualify for the 5% APM bonus under MACRA.” 

Stepping Stone to Commercial

More than half, 52%, of respondents said they applied to BPCI Advanced to prepare for commercial bundles. Commercial bundles are self-designed and self-guided programs, thus requiring a certain level of bundled payment expertise to achieve success.

At a recent conference, our chief analytics officer, Dr. Mah-J Soobader told audience members, “The pathway to commercial is experimenting in Medicare programs, and experimenting successfully.” Astute, future-minded providers who are planning to contract directly with commercial health insurance plans down the road are experimenting now with BPCI Advanced to gain the experience to manage their own bundle programs.

Vehicle for Change

Providers increasingly recognize the need to move from volume to value, but it is difficult to implement change without incentives, tools, data, or structure.  BPCI Advanced presents a framework for providers to ease into value-based case by providing:

  • Upside reward with downside risk protection
  • The opportunity to start small with just one bundle
  • Data to analyze in advance
  • The opportunity to drop out of the program at certain stages    

Just putting in an application can give providers insight into specific aspects of care and operations that have room for improvement and can spark a conversation between leaders about the best ways to go about it. 40% of respondents recognized this benefit of bundled payment programs and said they applied to the BPCI Advanced “to use the program as a vehicle for organizational change.”  

New Features More Attractive

BPCI Advanced builds on the original BPCI program with new features informed by data and provider feedback. One of those new features is an updated pricing methodology that has been adjusted to be more equitable and attractive to both low- and high-cost providers.

In our survey, 30% of respondents answered: “the refined pricing model might offer more incentive to their organization than that of the original BPCI program.” As providers prepare to receive their data and target prices in the coming months, it is important to keep in mind that success will be driven not just by your initial pricing, but also by your opportunity to increase savings relative to your peers over time.

Additional survey results revealed:

  • 67% of respondents that applied to BPCI Advanced had not participated in the original program
  • 39% of respondents have experience in risk-based contracts
  • When looking at a convener for partnership in BPCI Advanced, providers’ priority needs include analytics, bundled payment expertise, risk protection, and guidance in redesign among other things.

As Archway predicted when CMS first gave indication of BPCI Advanced, the program has attracted many providers new to bundled payments. We are excited by the response and committed to helping providers succeed.

For those who missed out this time, there will be another chance to apply in 2019.

Contact our team to learn more.