BPCI-Advanced Data Analytics and Program Support

The Center for Medicare and Medicaid Innovation (CMMI) recently announced its strategy to better integrate specialist physicians into Medicare value-based payment models. CMMI plans to share “enhanced specialty care performance data” with ACOs and other population-based model participants. CMMI also extended its BPCI Advanced payment model through 2025.

The Institute has deep expertise in episode payment models, and it has replicated the BPCI-A target pricing model using 100% of Medicare claims data. We can measure risk-standardized bundled payment spending for each ACO’s participating providers and generate benchmarking comparisons for hospital and specialty groups in your geographic market. Whether you would like episode performance data to help select hospitals and specialty physician partners for your ACO or you are interested in participating in BPCI-Advanced, the Institute offers a range of analytic solutions including reports that utilize the Episode Grouper for Medicine.

We are collaborating with the National Association of ACOs (NAACOS) to offer analytic reports and support services to help your organization through all stages of the episode payment and analytics journey. NAACOS members can download a free episode spending report.

Clinical Episode Opportunity Analysis Report

This report provides a spending profile for each 90-day BPCI-A episode for your ACO attributed beneficiaries including risk-adjusted spending by episode and triggering provider (e.g., hospital or orthopedic surgeon). The report will show you how your ACO’s episode spending compares with market averages overall and by type of service (post-acute care, acute readmission etc.) to help you identify opportunities for savings and to understand which of specialty care providers are more efficient.

BPCI-Advanced Market and Competitor Profile

This report provides a spending profile for each 90-day BPCI-A episode for your ACO attributed beneficiaries including risk-adjusted spending by episode and triggering provider (e.g., hospital or orthopedic surgeon). The report will show you how your ACO’s episode spending compares with market averages overall and by type of service (post-acute care, acute readmission etc.) to help you identify opportunities for savings and to understand which of specialty care providers are more efficient.

BPCI-Advanced Market and Competitor Performance Profile

This report shows you the episode volume, episode spending and efficiency (ratio of observed to predicted spending) for every major hospital and specialist group in your market for all 34 BPCI-A episodes. In combination with your opportunity analysis report, this will help you identify efficient bundle partners and inform your negotiations around gain sharing arrangements.

SNF Market Report

This report analyzes the efficiency of every SNF in your geographic market using a national model to compare observed to expected costs for the SNF stays and the total cost of care for the 30-, 60-, and 90-day periods after discharge from the SNF. The report is based on 100% of SNF’s Medicare admissions and will help your organization optimize your post-acute management strategy.

Custom Analytic Services

The Institute can provide detailed analyses based on your specifications to assess the factors driving episode spending in your organization and your market. We can work with your Medicare Advantage and commercial claims data to provide a more complete picture of efficiency of your bundle providers.

Program Support and Analytic Reporting for BPCI-Advanced Participants

We have substantial experience supporting organizations participating in BPCI and we can help you navigate the program rules, manage the historical and ongoing claims data provided by CMS, produce monthly, quarterly, and annual performance reports and educate your team about program dynamics and opportunities.

For more information, contact us at analytics@institute4ac.org