The Minnetonka, Minn.-based UnitedHealth Group said last week that it will offer data and analytics, technology and care coordination to support bundled payment models, including the Centers for Medicare & Medicaid Services’ (CMS) Bundled Payments for Care Improvement Advanced (BPCI Advanced) program.
Bundled payment models set price and quality standards for certain treatments, such as hip or major joint replacements, and reward participating care providers who exceed the established standards. This is a shift away from the common fee-for-service structure that pays care providers for each treatment.
Earlier this year, CMS announced its latest voluntary bundled payment model, called Bundled Payments for Care Improvement Advanced (BPCI Advanced). The model will qualify as an Advanced Alternative Payment Model (Advanced APM) under MACRA’s (the Medicare Access and CHIP Reauthorization Act) Quality Payment Program. Under the Advanced APM track in MACRA, providers take on financial risk to earn the Advanced APM incentive payment.
The model performance period for BPCI Advanced starts on October 1, 2018 and runs through December 31, 2023. Like all models tested by CMS, “there will be a formal, independent evaluation to assess the quality of care and changes in spending under the model,” the agency stated.
BPCI Advanced Participants may receive payments for performance on 32 different clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient). The 32 types of clinical episodes add outpatient episodes to the inpatient episodes that were offered in CMS’ Innovation Center’s previous bundled payment model (the Bundled Payments for Care Improvement initiative).
UnitedHealth Group’s officials noted that the organization’s experience using data and technology to help coordinate care and improve health outcomes positions the company as a strong partner for care providers participating in bundled payment programs. “This form of value-based care is a benefit both for the people needing treatment and the care providers delivering it, and UnitedHealth Group is committed to finding even more ways to expand its use,” officials said in a press release statement.