BPCI payment reform

BPCI payment reform is generating new savings opportunities.

The Bundled Payments for Care Improvement (BPCI) program has opened up significant opportunities to increase savings for healthcare organizations that are able to comply with BPCI payment reform requirements.

Introduced in 2013 by the Centers for Medicare and Medicaid Services (CMS), BPCI payment reform – also known as the bundled payment program – is a new paradigm in healthcare reimbursement. As opposed to the traditional fee-for-service model that reimburses providers based on quantity of services, BPCI payment reform programs reimburse providers based on the quality of care that patients receive. By incentivizing healthcare organizations and providers to coordinate care more effectively, BPCI bundled payment programs have been instrumental in helping to improve patient outcomes while reducing waste and lowering costs.

Many healthcare organizations that want to increase savings by participating in BPCI payment reform may find it difficult to marshal the capabilities and expertise required to manage the program. For these organizations, partnering with a convener can make a significant difference. Conveners are healthcare organizations that not only have the experience and technology to manage Medicare bundled payments effectively, but will also share risk and partner with health systems to drive success.

Participate in BPCI payment reform with support from naviHealth.

For healthcare organizations seeking to take advantage of the benefits of BPCI payment reform, naviHealth can be a key partner. With a suite of high-tech, high-touch care management solutions, we currently partner as a convener with more than 50 hospitals to manage roughly 40,000 annual episodes of care. Our team includes experts in BPCI payment reform – former Center for Medicare & Medicaid Innovation (CMMI) staff and national consultants who have successfully designed and implemented Medicare BPCI programs across the country. We are uniquely positioned to help organizations navigate the complexity of BPCI payment reform and to anticipate changes to BPCI in 2018.

With naviHealth, healthcare organizations can access the experience and expertise they need to:

  • Optimize financial results by lowering unnecessary utilization, reducing readmissions and lowering 90-day episode costs.
  • Reduce hospital readmissions by increasing physician alignment and engagement.
  • Improve patient outcomes through better coordination of care and by engaging patients more effectively in their own care plan.

An Experienced Partner

We’ve spent more than 18 years pioneering ways to improve every aspect of care transitions for health plans, providers and patients. From discharge planning efficiencies to managing risk for payors and providers, naviHealth is equipped to provide you with a tailored suite of capabilities.

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naviHealth technology and services for BPCI payment reform.

To enable healthcare organizations to participate in BPCI payment reform, we offer:

  • Clinical services, with more than 420 clinicians available to help guide patients to the next level of care.
  • Proprietary technology to impact savings and manage metrics that include PAC level of care, SNF utilization, high-quality PAC networks, and hospital readmissions.
  • Advanced analytics and reporting, and expert analysis of complex claim data sets to identify target areas for savings.

Learn more about BPCI payment reform and naviHealthsolutions to support Medicare Advantage programs.

The statements contained on this page are solely those of the author and do not necessarily reflect the views or policies of CMS. The author assumes responsibility for the accuracy and completeness of the information contained on here.


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