To better support healthcare providers
“To better support healthcare providers who invest in practice innovation, care redesign, and enhanced care coordination, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) has launched the Bundled Payments for Care Improvement Advanced (BPCI Advanced) voluntary bundled payment model. BPCI Advanced qualifies as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program.”
Supporting the continous reenginering of best practices, protocols and patient pathways.
Decrease the cost of each Clinical Episode by reducing variation and eliminating unnecessary or low-value care.
Improve quality while reducing spending.
Create an environment for peer-to-peer education and best case practice development through utilization of dynamic protocols and learning environments.
Encourage patient and support system engagement in care through use of expert-supported technologies, education modules, and on-going communication.
Payment and Risk Track
Single payment and risk track beginning on the day of triggering inpatient stay and extending 90 days post discharge.
Inpatient Clinical Episode Triggers
33 Clinical Episodes triggered by the submission of a claim for an inpatient hospital stay identified by applicable MS-DRG.
Four Outpatient Clinical Episode Triggers
Total Knee Arthroplasty, Percutaneous Coronary Intervention, Cardiac Defibrillator, and Back & Neck (except fusion).
Target Prices
Provided in advance of the first performance period and adjusted during a semi-annual adjustment.
