On January 9, 2018, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary bundled payment model, Bundled Payments for Care Improvement Advanced (BPCI Advanced). The model started on October 1, 2018, and CMS has indicated that there will be an additional opportunity for new entrants to start on January 1, 2020, with the application period opening in April 2019. BPCI Advanced replaces the current BPCI models, which have been in operation for five years.
The bottom line for organizations interested in pursuing BPCI Advanced is whether the potential rewards for participating offset the risks and costs associated with that participation. The BPCI Advanced program offers proactive industry stakeholders flexibility to develop innovative care and gainsharing models, even if they had not previously participated in BPCI. However, both new entrants and experienced entities in the bundled payment space will need to balance these opportunities with target price and contractual structuring considerations in order to determine how they are best positioned to participate in the program.
In this paper, Milliman’s Daniel Muldoon and Pamela Pelizzari examine several factors, which can influence an organization’s decision to enter BPCI Advanced, and, if appropriate, its decision to share risk with a convening organization.
Ropes & Gray’s Devin Cohen, Evander Williams, and Michael Lampert also co-authored the paper.
While alternative payment models (APMs) have increased in popularity over recent years, they can be difficult to implement because of their operational dependence on payment systems designed for fee-for-service (FFS) reimbursement. In addition, moving away from a FFS reimbursement construct can cause underreporting of detailed services. As a result, many APMs undergo financial settlements, meaning payments flow as normal during model performance periods and are retrospectively reconciled to a target price or benchmark after the fact.
APM financial settlement data offer providers opportunities to validate financial calculations, understand methodology, and enhance patient management. Providers can also gain perspective on other revenue drivers such as patient retention.
In this paper, Milliman consultants explore APM reimbursement methodologies through the lens of the Centers for Medicare and Medicaid Services (CMS) Oncology Care Model as an illustrative case study.
With the shift to value-based payment for healthcare in the United States, an array of alternative payment models (APMs) has emerged that introduce challenges along with opportunities for providers. This paper by Milliman consultants highlights the key aspects of APM payment methodologies and uses the Centers for Medicare and Medicaid Services Oncology Care Model as a case study to illustrate these concepts.
Alternative payment models (APMs) have become a popular way to tie payment to quality of care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) created incentives for providers to participate in APMs. This paper by Daniel Muldoon and Pamela Pelizzari explores key clinical and financial considerations that need to be addressed in a robust APM proposal.
The Centers for Medicare and Medicaid Services released final rules related to episode payment models on January 3, 2017, and May 19, 2017. This paper by Milliman consultants Pamela Pelizzari and Daniel Muldoon outlines the major provisions of the final rules and suggests possible implications for affected providers.