CMMI Model Reports and Findings

Bundled Payments for Care Improvement Advanced Model

Evaluation of Model Year 5 (2022) – Key Takeaways:
The goal of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model is to reduce Medicare spending while maintaining or improving quality of care by holding participants financially accountable for the cost and quality of health care services during an episode.

Episodes begin with a medical or surgical hospital stay or an outpatient procedure initiated by a participating hospital or physician group practice (PGP) and end 90 days after the patient leaves the hospital.

Model participants can earn a reconciliation payment if episode payments are below their target price, or they may be required to repay Medicare if episode payments are above their target price, after considering the quality of their care. This payment approach encourages participants to reduce unnecessary services and coordinate care across all providers involved in the episode.