Participation in Model Year 7 launched on Jan. 1, 2024, with the first few months being a critical time for providers. New Bundled Payments for Care Improvement Advanced Model (BPCIA) participants got their footing, and continuing participants were able to change their clinical episode service line groups for the first time since 2020.  If you’re a provider participating in this model, read on for a BPCIA refresher and four fast facts for starting MY7 right. We’ll also cover core analytics activities to support your clinical and operational success.   4 Fast facts on BPCIA Model Year 7  1.   Focus on clinical episodes and episode volume  Before MY7 began, providers used historic baseline data provided by CMS to evaluate which CESLGs they would go at risk for, ensuring there would be sufficient episode volume. Large episode volume (100 episodes/year or more) reduces random variation and helps protect providers from financial risk associated with outlier...

CMS released important updates for Model Year 7 of Bundled Payments for Care Improvement Advanced. Providers who applied and have been accepted into the third cohort will soon begin the baseline evaluation and episode selection process. In this blog, we’ll cover important upcoming BPCIA dates and what you need to know now and for the future. Important upcoming CMS BPCIA dates Here are important BPCIA dates you’ll want on your radar in the coming months: September 2023 : At the beginning of the month, CMS will upload preliminary BPCIA Model Year 7 episode target prices and baseline episode and claims data on the CMS Enterprise Portal. As a provider, you will need to use these data to evaluate which clinical episode service line groups you want to participate in during the new model year. Dec. 4, 2023 : Providers who choose to move forward in the model have until this date to submit their MY7 Participation Agreement and Participant Profile, which will indicate selected episode initiators...

CMS’ Bundled Payments for Care Improvement Advanced program will soon kick off a two-year program extension through 2025. Model Year 7 (Jan. 1 - Dec. 31, 2024) will be the first time that current participants (acute care hospitals and physician groups) can update their episode of care selections since 2020. MY7 is also only the second time since BPCIA launched (2018) that CMS will allow new providers to join. Applications were due May 31, 2023. Whether you’re a new applicant or a current participant looking to update your episode selections to improve results, it’s never too early to prepare. BPCIA participants take on immediate full risk. This makes it critical to choose episodes that present the greatest savings, incentive and quality improvement opportunities. Episode selection — An art and a science For optimal BPCIA episode selection, providers must analyze their performance from the historic baseline period and design their clinical effectiveness strategies accordingly. It’s impo...

As healthcare professionals continue to navigate the COVID-19 pandemic, it's important to understand how it has impacted healthcare trends. “Trends in Sepsis and Pneumonia During COVID-19: Lessons From BPCIA,” a recent research article published in The American Journal of Managed Care, explores how COVID-19 has impacted sepsis and pneumonia care and costs. Coauthored by Alyssa Dahl, DataGen’s senior director of advanced analytics, and John Kalamaras, DataGen’s director of business intelligence analytics, along with experts from the Association of American Medical Colleges, the article explores the changes in cost and utilization for sepsis and pneumonia in non-COVID-19 episodes before and during the pandemic, and during the pandemic for patients with and without COVID-19. The analysis used claims data from eight teaching hospitals participating in sepsis and pneumonia episodes in the Bundled Payments for Care Improvement Advanced model. BPCIA is a Medicare value-based care bundle...

The Bundled Payment for Care Improvement (BPCI) Advanced Model is now open for applications until May 31, 2023. This model provides a unique opportunity to acute care hospitals and physician group practices who are looking to: evaluate their bundle performance; rejoin if they have previously dropped out due to being under a convener; or take advantage of the changes to the model. With a small window to sign the participation agreement, you’ll need experts to process data quickly and accurately for evaluation. BPCI Advanced Program Details The Centers for Medicare & Medicaid Services (CMS) announced in October 2022 that this program will extend from January 2024 to December 2025. Data used for evaluation will be taken from the baseline period between October 2018 and September 2022. A participation agreement will be sent out in September 2023 and needs to be signed by October 2023 in order to participate. Those who apply before the May 31 deadline will benefit ...

CMS recently made several major announcements about the Bundled Payments for Care Improvement Advanced Model.  The model, which was due to expire at the end of 2023 (Model Year 6), will be extended for an additional two years through Dec. 31, 2025.  New applications will be accepted in 2023 for the two-year extension. Participants still active in Model Year 6 can continue without reapplying by signing an amended and restated participation agreement for Model Year 7.  New methodological changes will be implemented for Model Year 6, which starts on Jan. 1, 2023. Methodological changes include that: the CMS Discount Factor 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%; the Major Joint Replacement of the Upper Extremity clinical episode category will become a multi-setting episode category by allowing episodes to be triggered when the procedure is performed...

Alternative payment programs are critical to payment and care delivery transformation. CMS is introducing new alternative payment models that provide opportunities to deliver better value of care and support healthcare innovation in the years to come. Rising healthcare trends should be taken into consideration when evaluating new APMs. Yet, keeping ahead of which programs offer you the greatest opportunity can be a major challenge. DataGen put together Navigating Alternative Payment Models: A User's Guide , offering insights on the participation categories—and detail on programs within each category—this resource can help you determine the best course for your organization’s future. Download our user's guide to learn about new APMs, implications for providers and data-driven strategies for successful pro gram execution.

The COVID-19 pandemic has impacted every aspect of our healthcare system. That’s true for participants in the Oncology Care Model and Bundled Payments for Care Improvement Advanced programs. Organizations in these programs had to make important decisions regarding the overlap of their program performance periods with the COVID-19 public health emergency. Several trends have begun to emerge from these choices. Here’s what DataGen’s analysts have seen from the data: BPCIA For performance periods that overlapped with the PHE, BPCIA participants had to decide if they would remove all upside and downside risk, or just remove COVID-19 patients from their reconciliation. From our analysis, it appears that decisions were balanced between these two options. We are not aware of any episode initiators who chose to continue their reconciliations as usual with no exclusions at all. Here’s what we believe drove those decisions: Opting out of the performance period reconciliation entirely by removing...