So you’re considering BPCI-Advanced, eh? Which means you’re most likely up to your eyeballs in data right now trying to figure out your positioning.  Over the next 1 month and 15 days, you have some big decisions to make; “Which episode initiators are you going to contract with?”; Which clinical episodes are you going to participate under?”; not to mention trying to evaluate if the internal structure, resources, and care pathways are in place.  

My advice, even if you have already participated in one of the BPCI Classic models, get intimate with your data. BPCI-Advanced is significantly different than prior models, and while there may be potential gains there are also considerable risks.  

A few things to consider before committing:

  1. Risk is immediate in BPCI-A. There is no six-month phase-in approach like there was with BPCI classic models 2,3, and 4. Starting 10/1/2018 when Model Year 1 kicks off, you are immediately on the hook for your performance.
  2. Your peers will impact your target pricing.  BPCI-A’s benchmark pricing methodology now looks at patterns of spending relative to the Census Region/peer data, where before it looked at the participants’ historical claims data only
  3. BPCI-A offers a single risk track. Cases falling within the 1st/99th percentile will be excluded, whereas in the BPCI Classic models you had a choice between 1st/99th,  5th/95th, and 5th/75th percentile risk tracks.
  4. Reconciliation and target price setting will occur less frequently. Under BPCI-A reconciliation will occur bi-annually on 6/30 & 12/31 as opposed to quarterly, like other models.  Target prices will no longer be provided at reconciliation; instead, they will be prospectively set before the start of each Model Year.
  5. Quality is now a factor in reconciliation.  In BPCI Classic models, EI’s were not accountable to quality measures whereas in BPCI-A there are potentially 7 quality measures that apply (depending on the clinical episodes you participate in).  Keep in mind, everyone will be required to report on the process measure Advanced Care Plan (NQF #0326).

Keep in mind if you decide that the risk may be greater than the reward for Model Year 1, there is always Model Year 2, which CMMI will be accepting applications in the Spring of 2019.