BPCI Model 3: Retrospective Post Acute Care Only

Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality, more coordinated care at a lower cost to Medicare.

For Model 3, the episode of care will be triggered by an acute care hospital stay and will begin at initiation of post-acute care services with a participating skilled nursing facility, inpatient rehabilitation facility, long-term care hospital or home health agency. The post-acute care services included in the episode must begin within 30 days of discharge from the inpatient stay and will end  either a minimum of 30, 60, or 90 days after the initiation of the episode. Participants can select up to 48 different clinical condition episodes.

BPCI Model 3 mappedClick anywhere on the map to view the interactive version

There are 43 participants/awardees involved in the BPCI Model 3: Retrospective Post Acute Care Only. Many participants/awardees comprise numerous sites and can be accessed as a (List).
To view an interactive map of this Model, visit the Where Innovation is Happening page.

Background

In both Models 2 and 3, the bundle will include physicians’ services, care by post-acute providers, related readmissions, and other related Medicare Part B services included in the episode definition such as clinical laboratory services; durable medical equipment, prosthetics, orthotics and supplies; and Part B drugs. A target price will be set that will be based on historical fee-for-service payments for the participant’s Medicare beneficiaries in the episode and will include a discount. Payments will be made at the usual fee-for-service payment rates, after which the aggregate Medicare payment for the episode will be reconciled against the target price. Any reduction in expenditures beyond the discount reflected in the target price will be paid to the participant and may be shared among their provider partners. Any expenditures that are above the target price will be repaid to Medicare by the participant.

Medicare currently makes separate payments to providers for the services they furnish to beneficiaries for a single illness or course of treatment, leading to fragmented care with minimal coordination across providers and health care settings. Payment is based on how much a provider does, not how well the provider does in treating the patient.

Research has shown that bundled payments can align incentives for providers – hospitals, post acute care providers, doctors, and other practitioners – to partner closely across all specialties and settings that a patient may encounter to improve the patient’s experience of care during a hospital stay in an acute care hospital, and during post-discharge recovery.

The Bundled Payments for Care Improvement initiative includes two phases for Models 2, 3, and 4. Phase 1, also referred to as the “preparation” period, is the initial period of the initiative during which CMS and participants prepare for implementation and assumption of financial risk. Those participants in Phase 1 of Models 2, 3, and 4 that are approved by CMS and intend to assume financial risk for episodes may enter into a Bundled Payments for Care Improvement Model agreement with CMS as Awardees and begin Phase 2, also referred to as the “risk-bearing” period.

On January 31, 2013, the first set of Bundled Payments for Care Improvement Phase 1 participants were announced.  Phase 2 began either on October 1, 2013 or January 1, 2014 for Awardees that have entered into Model 3 Awardee Agreements with CMS, at which point Awardees began the risk-bearing phase for some or all of their episodes. During the transition period, Phase 2 Awardees may transition episodes and/or episode initiators that have remained in Phase 1 to Phase 2 on a quarterly basis.

Models 2–4 Open Period Information

The Center for Medicare & Medicaid Innovation is announcing an open period for additional organizations to be considered for participation in Models 2-4 of the Bundled Payments for Care Improvement initiative. Access to additional information and resources are available on the Models 2-4 Open Period Information web page.

 

Model 3 Participants

Phase 1 Participants

  • Amedisys Holdings (Baton Rouge, LA): This Awardee is a convener of health care facilities in AL, AZ, CT, GA, ID, KY, LA, ME, MS, NH, NY, OH, OR, PA, SC, TN, VA, WV, and WY in Phase 1.
  • Cathleen Naughton Associates, Inc. (Providence, RI):  This participant is participating in Phase I in collaboration with the convener, CareLink (Providence, RI).
  • Chatsworth at Wellington Green, LLC (Wellington, FL): This Awardee is a convener of health care facilities in FL in Phase 1.
  • Dupage Medical Group LTD (Downers Grove, IL): This participant is participating in Phase 1 in collaboration with the convener, Illinois Bone & Joint Institute, LLC (Des Plaines, IL).
  • Good Samaritan Society - Prescott Village (Prescott, AZ): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Prescott Valley (Prescott Valley, AZ): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Bonell Community (Greeley, CO): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Kissimmee Village (Kissimmee, FL): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Idaho Falls Village (Idaho Falls, ID): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Davenport (Davenport, IA): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Ottumwa (Ottumwa, IA): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Specialty Care Community (Robbinsdale , MN): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Hastings Village (Hastings, NE): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Millard (Omaha, NE): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Denton Village (Denton, TX): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Lake Forest Village (Denton, TX): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Colorado Home Care (Longmont, CO): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society Carea (Kissimmee, FL): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Home Care (Golden Valley, MN): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Home Care (Roseville, MN): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Home Care of Central Nebraska (Kearney, NE): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Omaha Metro Home Care (Omaha, NE): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society - Home Care (Sioux Falls, SD): This participant is participating in Phase 1 in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Optum (Brentwood, TN): This Awardee is a convener of health care facilities in NY and MI in Phase 1.
  • PA Holdings-SNF, LP (Timonium MD): This Awardee is participating in collaboration with convener Mid-Atlantic Health Care. This Awardee is also a convener of health care facilities in AL, CA, CO, CT, FL, GA, IL, KY, MA, MI, MS, NC, NE, NY, OH, PA, SC, TN, TX, WI, WV, and WY in Phase 1.
  • Remedy BPCI Partners, LLC (Darien, CT): This Awardee is a convener of health care facilities in AK, AL, AZ, CA, CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, and WY in Phase 1.
  • Scandinavian Home, Inc. (Cranston, RI): This participant is participating in Phase I in collaboration with the convener, CareLink (Providence, RI).
  • Tockwotton Home (East Providence, RI): This participant is participating in Phase I in collaboration with the convener, CareLink (Providence, RI).

 

Phase 2 Awardees

  • Amedisys Holdings (Baton Rouge, LA): This Awardee is a convener of health care facilities in IN, KY, and SC in Phase 2.
  • Brooks Health System (Jacksonville, FL): This Awardee is a convener of health care facilities in FL.
  • CareLink Inc. (Providence, RI): This Awardee is a convener of health care facilities in RI.
  • Chatsworth at Wellington Green, LLC (Palm Beach Gardens, FL)
  • Golden Living (GGNSC Administrative Services, LLC) (Washington, DC): This Awardee is a convener of health care facilities in CA, PA, and WI.
  • Good Samaritan Society – Ambassador (New Hope, MN): This Awardee is participating in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society – Luther Manor (Sioux Falls, SD): This Awardee is participating in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society – Maplewood (St. Paul, MN): This Awardee is participating in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society – Sioux Falls Center (Sioux Falls, SD): This Awardee is participating in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Good Samaritan Society – Sioux Falls Village (Sioux Falls, SD): This Awardee is participating in collaboration with the convener, the Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD).
  • Homefront Health Care ( Providence, RI): This Awardee is participating in collaboration with the convener, CareLink (Providence, RI).
  • Illinois Bone & Joint Institute, LLC (Des Plaines, IL)
  • Kindred Healthcare (Louisville, KY): This Awardee is a convener of health care facilities in OH.
  • Mid-Atlantic Health Care (Timonium, MD): This Awardee is a convener of health care facilities in PA.
  • Optum (Brentwood, TN): This Awardee is a convener of health care facilities in IL, MI, NJ and PA in Phase 2.
  • PA Holdings-SNF,LP (Timonium MD): This Awardee is participating in collaboration with convener Mid-Atlantic Health Care. This Awardee is also a convener of health care facilities in PA in Phase 2.
  • Remedy BPCI Partners, LLC (Darien, CT): This Awardee is a convener of health care facilities in NY and TX in Phase 2.
  • Saint Antoine Residence (North Smithfield, RI): This Awardee is participating in collaboration with the convener, CareLink (Providence, RI).
  • Saint Elizabeth Home (East Greenwich, RI): This Awardee is participating in collaboration with the convener, CareLink (Providence, RI).
  • Saint Elizabeth Manor (Bristol, RI): This Awardee is participating in collaboration with the convener, CareLink (Providence, RI).
  • St. Clare Home for the Aged (Newport, RI): This Awardee is participating in collaboration with the convener, CareLink (Providence, RI).
  • Steere House Nursing & Rehabilitation Center (Providence, RI): is participating in collaboration with the convener, CareLink (Providence, RI).
  • The Evangelical Lutheran Good Samaritan Society (Sioux Falls, SD): This Awardee is a convener of health care facilities in SD.

Additional Information



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