The Bundled Payments for Care Improvement (BPCI) Advanced model is a new initiative from the Centers for Medicare and Medicaid Services (CMS). This program builds on the success of the original BPCI program and aims to improve quality and lower patient costs.
We will discuss the quality measures included in the BPCI Advanced model. We will also provide an overview of how these measures work and what you need to do to participate in this program.
The Bundled Payments for Care Improvement Advanced (BPCI Advanced) model is a voluntary, five-year payment reform program sponsored by the Centers for Medicare and Medicaid Services (CMS). BPCI Advanced encourages providers to transition from volume-based care to value-based care. Under this model, a provider or health system is at risk for delivering a bundle of services for an episode of care, such as hospitalization or post-acute care. It is rewarded with shared savings if it can deliver quality outcomes at lower costs.
To ensure that participants in the BPCI Advanced program meet established quality standards, CMS has developed a set of quality measures that may be used to evaluate the effectiveness of care. These quality measures are based on evidence-based clinical guidelines and reflect initiatives from various government, public health, and private organizations.
Participants must track and report on administrative quality measures when participating in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model. These measures focus on improving patient experience, increasing access to care, and engaging with healthcare providers.
The Quality Measure Set includes:
In addition to the administrative quality measures, participants must also track and report on a set of alternative quality measures. These measures focus on providing value-based care that improves patient outcomes while reducing costs. The Alternative Quality Measures Set includes:
Average 30-day all-cause readmission rates
By tracking quality measures, participants in the BPCI Advanced Model gain a comprehensive understanding of care delivery for their patients, allowing them to identify areas of improvement and increase efficiency. This helps ensure that they provide the highest quality care while also reducing costs, thus creating a successful program for all participants.