Toward Accountable Payment

Putting CMMI's newest (and biggest) program on the map


Jordan Stone

Last month, the Center for Medicare and Medicaid Innovation (CMMI) announced that more than 450 hospitals and post-acute providers were selected for the Bundled Payments for Care Improvement (BPCI) initiative. Participating providers will be reimbursed through single case rates for select episodes of care, combining payment for a variety of related hospital, physician, and post-acute services.

Although the BPCI initiative just launched in February, it already includes more participants than CMS’s two flagship accountable payment programs, the Medicare Shared Savings Program (MSSP) and Pioneer ACO Model. BPCI includes a diverse collection of providers with facilities in 44 states, contracting for nearly 9,000 combined medical and surgical bundles across inpatient and post-acute settings.



Mapping the BPCI participants

Number of participants by state

Several regions of the country—and even in specific states—have a high concentration of providers joining the new bundling program. For example, the Northeast region proved to be a high-density region for BPCI: facilities in Pennsylvania, New York, and New Jersey make up nearly a third of the provider cohort. 

Particularly active corridors in the Midwest and Southwest combine to account for another third of the BPCI participants. And among large states, Texas has relatively little participation; while more than 60 organizations submitted non-binding letters of intent (LOIs) last year, only 19 providers ultimately decided to participate in BPCI. 


Different trends across the country

The BPCI participation map also shows a few noticeable absences. Characteristically progressive states such as Oregon and Washington are missing from the provider cohort—but this does not indicate a lack of interest in accountable payment programs in either state. Oregon is now embarking on a multi-billion dollar pilot that takes a value-based approach to the Medicaid program, and CMMI awarded Washington a million dollar innovation prize to aid the creation of numerous “virtual ACOs” throughout the state.

In some cases, the participation trends relate to the four bundling models within BPCI. A single convener in New Jersey, for example, is coordinating efforts among all but three of the 32 providers participating in Model 1, the inpatient “pay-to-play” gainsharing variant of BPCI.

Meanwhile, a considerable number of independent applicants (i.e., providers not working with a third party convener) in the Southwest and only a handful of larger conveners will implement Model 4, which bundles together inpatient hospital and physician services plus related readmissions.

Additional Resources

Read about the early experience of bundling sites in Medicare’s Acute Care Episode (ACE) Demonstration—the precursor to BPCI—in our study, Succeeding Under Bundled Payments. Learn more about our ability to help organizations design and manage risk-based payments through our new Payment Transformation Initiative.

Please feel free to call or email Rob Lazerow at LazerowR@advisory.com with your questions and comments.



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