BPCI-A MY4 Blog Graphic Clarify Health

Model Year 4 baseline data is out! Last week CMS released data to all participants in the Bundled Payments for Care Improvement Advanced (BPCI-A) program. The decisions hospital and physician group practice (PGP) participants must make by mid-December has broad implications, especially as mandatory bundles from CMS become more of a certainty in 2024. In our previous post, we summarized these changes and described what a robust diagnostic should be able to accomplish. In this second post in our series, we will provide a few examples of how Clarify’s analytics platform has helped our customers consistently achieve bonuses across value-based care episodes.

Achieving success in BPCI Advanced involves two over-arching considerations:

  1. Choosing the best Service-Hospital combinations for participation
  2. Surfacing real and achievable opportunities for impact

While obvious, fully addressing these considerations requires robust insights, anything but simple even for the most experienced in bundles.

Choosing the best Service-Hospital combinations for BPCI Advanced participation

As is the case with many CMS value-based programs, participants must painstakingly, manually crunch their data (or hire someone) only to be left making educated assumptions about participation – but with mandatory bundles on the horizon, settling for best-guess answers shouldn’t be the norm.

Two key elements to Clarify’s value-based program diagnostic have helped our clients confidently choose the right ways to participate in BPCI-A:

  • 98%+ Accurate BPCI-A Episode Target Price Calculations: We took on the painstaking process of reproducing BPCI-A target price calculations and channeled these through our platform so that we can calculate target prices at the patient-level and aggregate them for each episode
  • Application of regional and peer trends to forecast performance across all BPCI-A episodes with scenario modeling.

The below shows an example output in Clarify’s analytics platform, which this customer used to select episodes for MY3. For MY4, this diagnostic now groups episodes into appropriate service lines, but still retains the ability to drill down to the episode type level.

Clarify Health BPCI-A Diagnostic screen

Surfacing real and achievable opportunities for impact in BPCI Advanced

Once in the BPCI Advanced program, achieving success requires an ongoing line of sight to real clinical variation and achievable performance improvement opportunities. Clarify’s unique ability to layer insights and highlight areas of opportunity has enabled our clients to consistently succeed in their selected bundles. Clarify combines patient-level target-price calculations with our machine-learning modeling. Our powerful tech stack runs models on our immense nationwide dataset (including 100% complete Medicare data), which ultimately enables high-precision risk-adjustment. As a result, the Clarify Platform can identify meaningful clinical variation which factors in the specific clinical attributes of each patient. Below are current examples from 3 different Clarify customers of different sizes and appetites for participation.

Clarify Health BPCI-A Bonuses per episode

Interested to see how Clarify can power your success in BPCI-A? Schedule a call with our experts to l about Clarify’s BPCI-A Diagnostic and Management services.