Bundled Payments 2.0 Coming Soon

Home health care providers have become an integral part of bundled payment initiatives, and more are likely on the way.

Bundled Payments for Care Improvement (BPCI) 2.0 or Advance BPCI is expected to be announced by the Centers for Medicare & Medicaid Services (CMS) imminently, providing an opportunity for home health to get in on the action as these programs expand.

BPCI, which intends to align providers from across the continuum to coordinate a single episode of care, is comprised of four care models that link payments for multiple services.

The incoming next generation is likely to expand upon the popular model 2 bundle, which ties the total cost of care of an episode reconciled against a target price determined by CMS. A payment or recoupment amount is made to participants reflecting the performance compared to the target price.

“[It is expected] it will be based largely on the current BPCI program, especially model 2,” Clay Richards, CEO of naviHealth, told Home Health Care News. “CMS has sought feedback from a data and pricing standpoint. CMS has been asking how to take some of the lessons learned in the first three or four years of experience and make the pricing model more predictable so larger companies want to participate.”

The Brentwood, Tenn.-based naviHealth is a post-acute care transitions company and one of the largest conveners of bundled payments.

CMS is likely to standardize the pricing model of bundles in BPCI 2.0, according to Richards. Pricing is currently based on individual costs for hospitals and physicians groups, he said.

A more standardized approach is likely to attract bigger health care systems to engage in more bundles, as the program will have more predictability. Expanding the program overall is also a significant opportunity for home health care providers to become referral partners with major health systems, Richards said.

“It’s been incredibly important to have quality home health partners to work with,” Richards said. “We have seen that an increase in home health utilization has a corresponding decrease in readmissions, which is exactly what the program aims to accomplish.”

As results from the first few years of BPCI models continue to flow in, more opportunity remains for home health providers, and agencies that are capable of proving their effectiveness will be well positioned as these programs expand, Richards says.

“Home health care is a cheaper setting than other institutions, where patients are able to be in a stable environment,” Richards said. “Home health agencies view the next version of BPCI very favorably.”

As the next version of BPCI is expected, the industry has also been keeping an eye on statements from President Trump’s leadership. The expansion and introduction of some BPCI models was already put on hold, and current Health and Human Services (HHS) Secretary Tom Price has voiced his preference for voluntary programs instead of mandatory initiatives.

However, the bundles are likely to continue rolling out as the health care system continues its charge toward value-based care.

“The program has been a big success, financially and from a quality standpoint,” Richards said.

Written by Amy Baxter

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