BPCI-A Loss Protection
BPCI-A Loss Protection protects participants against the Repayment Amount at reconciliation. BLISCare removes the uncertainty of a reconciliation event by fixing the cost to participate.
The Problem
The BPCI-A Initiative is an Advanced Alternate Payment Model (APM) in which healthcare providers agree to receive a single payment for physician, hospital and other healthcare services for specific diagnoses within an episode of care for the Medicare population. Within the program, participants (Non-Convener Participants, Episode Initiators, and Conveners) assume the risk of costs exceeding the targeted single payment, therefore owing CMS a Repayment Amount at reconciliation, all for the potential upside of the Net Payment Reconciliation Amount (NPRA) due to them from CMS if the total costs are managed under the single payment amount.
The issue for providers in the program is the wide range of variability of the upside and downside (+/- 20% of the target price). Even more so, the risk lies in the uncertainty of the reconciliation outcome as many costs incurred are outside the control of the provider. More recently in model year 4 (2021), CMS changed the ability for providers to elect to participate with individual episodes within episode groupings, and now are required to participate in all the episodes in the grouping, dramatically accentuating the risk of the program for the provider.
Our Solution
BLISCare enables providers to intelligently manage their risk in the BPCI-A program. BLISCare assumes the responsibility and risk of the Repayment amount for a small per episode fee, without requiring any of the Net Payment Reconciliation Amount (NPRA) in return. BLISCare provides BPCI-A Participants the following benefits:
Cost Certainty - fixes the cost of the downside risk to participate in the program
No NPRA Sharing - no requirement to share cost savings
Performance Reward - risk fees are adjusted over time to accurately align with actual performance period results
“Managing the fluctuating changes in BPCI-A, especially target price variations and high cost outliers are constant challenges for all participants. BLISCare provides the needed risk protection to eliminate the stress and worry over financial success.
Utilizing BLISCare for risk protection in BPCI Advanced allows providers to focus on delivering care redesign without worrying about the financial rollercoaster.”