Balancing Multiple APM Programs: BPCI Advanced, ACOs, and More

The final enrollment window for BPCI Advanced is now open, and we have already received questions from providers about how to think about BPCI Advanced in the context of other alternative payment models (APMs), such as Medicare accountable care organizations (ACOs) and other bundled payment programs. 

For some providers, the question is less about whether they specifically want to join BPCI Advanced, and more about planning for the addition of another risk-based program to their organization’s profile. 

Why join multiple APMs? 

Joining multiple APMs is not a requirement and is a decision that each organization should make for itself, based on its patient population, care goals, and financial needs. Yet as CMS continues to push providers toward APMs with new primary care models released last week and others on the way, many providers may find themselves needing to join multiple risk programs to meet patient or payment threshold levels in order to stay on the Advanced APM track in the Quality Payment Program and avoid having to follow MIPS reporting requirements

For providers that have reached this point in their value-based care journey, BPCI Advanced provides an opportunity to not only meet the thresholds, but also to earn savings as a reward for quality care at reduced cost. Bundled payment programs such as BPCI Advanced have been proven to succeed in engaging specialists, making them particularly complementary to programs geared toward primary care, such as ACOs.

Tips for Managing Multiple APMs

When balancing multiple APMs, there are a few high-level keys to success. 

  1. Put quality first
    All APMs are primarily about improving care quality. The financial benefits are secondary. Implementing and ingraining a patient-centered care model frees clinicians to think less about programs and more about populations. In many APMs, there is usually an opportunity to start with low-hanging fruit such as post-acute utilization or investing in top-performing physicians. Then, providers can move on to addressing other quality drivers such as behavior, environment and other social determinants of health. 

  2. Simplify your programs  

    Sometimes it’s OK to go one-size-fits-all. With multiple programs, many providers have found success approaching their programs with uniformity and simplicity. You can use overlap among the programs to your advantage. For example, many APMs have overlapping quality metrics. Providers can identify which metrics are most impactful to patients and approach care redesign with uniformity across the board. This allows you to zero in on specific improvements that have widespread impact. 

  3. Use your data wisely 
    Strong analytics are paramount to the success of any APM. It can be advantageous to look at the data from multiple programs together. Aggregate the data in a way that gives a full population view, allowing you to see trends across different patient populations regardless of the program with which they are associated. 

  4. Ensure clear education, communication, and engagement of stakeholders 
    When you take into account the “quadruple aim,” keeping physicians happy in an atmosphere of change should also be a priority. Physicians may perceive participation in multiple programs as a source of frustration, seeing more rules, regulations, and documentation. Listening to the physicians driving your care and not overwhelming them is crucial to making sure they stay on board.   

  5. Know You’re Not Alone 
    No matter the program, the goals are the same – improve care quality and outcomes at lower costs. In BPCI Advanced, there are nearly 1,300 providers striving to meet those goals. And, in any APM, you join a growing number of innovators in value-based care doing the same. Archway is proud to partner with a number of these providers on their journeys, and we are ready to support your organization in the way that best fits your needs. Whether you need a convener to share risk or are ready to hold your own contract with CMS, we have the team and technology to support your programs.  

If you have specific questions about BPCI Advanced or balancing your programs, reach out to Archway's value-based care team