Centers for Medicare & Medicaid Services (CMS): BPCI Advanced Program

The Bundled Payments for Care Improvement (BPCI) Advanced program is a Medicare initiative that aims to improve the quality and efficiency of healthcare by incentivizing healthcare providers to work together to coordinate care for patients. The program is focused on episodes of care, which are defined as a set of healthcare services provided to a patient for a specific medical condition over a defined period of time.

Under the BPCI Advanced program, participating providers agree to accept a fixed payment for an episode of care, rather than receiving separate payments for each service provided. This payment model is intended to encourage providers to work together to optimize care for the patient and reduce unnecessary or duplicative services.

The BPCI Advanced program is voluntary, and providers can choose to participate in one of four models:

Model 1: Retrospective bundled payment Model 2: Prospective bundled payment Model 3: Partial capitation Model 4: Full capitation Each model involves different levels of risk and reward for participating providers, depending on the degree to which they are responsible for the costs of care.

Overall, the BPCI Advanced program is intended to improve the quality and efficiency of healthcare by encouraging providers to coordinate care and reduce unnecessary or duplicative services.