CMS

Build, Buy, or Both: Tips for Directly Contracting with CMS in BPCI Advanced

Build, Buy, or Both: Tips for Directly Contracting with CMS in BPCI Advanced

With the next and final enrollment opportunity to join the voluntary BPCI Advanced program to open soon, healthcare organizations must consider not only if they will participate, but also how they will participate. More health systems and physician practices joined the first cohort of BPCI Advanced as episode initiators, and directly contracted with CMS rather than going through a convener.

Why Apply to BPCI Advanced Cohort 2?

Why Apply to BPCI Advanced Cohort 2?

The CMS announcement of a second enrollment window this April for the BPCI Advanced program brings a new opportunity, and last chance, for providers to participate in the program and get ahead of payment reform. For providers considering joining, the important first step to take toward BPCI Advanced is to secure the option to participate. The non-binding application process allows providers to acknowledge their interest, receive valuable CMS data, and evaluate the potential for success.  

So, why submit a non-binding application to Cohort 2?

Early Lessons in BPCI Advanced: 5 Takeaways from the March 1 Withdrawal Deadline

Early Lessons in BPCI Advanced: 5 Takeaways from the March 1 Withdrawal Deadline

On March 1, providers participating in BPCI Advanced had the option of dropping bundles or dropping out of the program entirely. The Centers for Medicare & Medicaid Services (CMS) provided this option to the more than 1,500 providers that began the program in October 2018, creating an effective “trial period” in this voluntary model. 

Now, more than 1,200 providers remain in the program. Additionally, CMS announced that it will open a new window for a second cohort of providers to join at the beginning of 2020. After six months of early results, there are some observations and lessons we’ve gathered that should be useful to new providers considering the program. 

CMS to Release Preview Target Price Summary Workbooks

On May 17, CMS hosted a webinar on the BPCI Advanced Pricing Methodology. During the webinar, CMS provided a detailed overview of the steps involved in setting BPCI Advanced Target Prices, and some new information on the pricing methodology including the use of a compound lognormal distribution to account for a provider’s patient case mix. 

Archway is excited by the granularity CMS will use in setting prices in BPCI Advanced, as it aims to encourage both high- and low-cost providers to participate and incentivize the delivery of high-value care.  
 
At the conclusion of the webinar, CMS announced they will soon be releasing Preview Target Price Summary Workbooks that contain a detailed breakdown of all relevant Target Price components. While these Preview Workbooks contain sample data only, the provision of these workbooks allows Archway to fully understand the program pricing methodology and data parameters in advance of receiving real data and target prices later this month. Components included in the workbooks include:
 
•    Peer group characteristics and spending trends used to construct PAT factors  
•    Risk Adjustment parameter estimates from the baseline period   
•    Patient-level characteristics by bundle category and patient covariates at the Episode Initiator level
•    Physician group practice (PGP) offset calculations for low- and high-cost PGPs

Archway is hosting a webinar next week on these topics and encourage you to join to learn more. Archway’s Chief Analytics Officer, Mah-J Soobader, Ph.D., MPH, will discuss the implications of the Workbook detail.

Register now for Archway’s next BPCI Advanced webinar on Thursday, 5/24, 1:30 – 2:30 pm EST.